Lung carcinosarcoma as a rare biphasic sarcomatoid carcinoma: a case report
© licensee BioMed Central Ltd. 2009
Received: 3 December 2008
Accepted: 26 December 2008
Published: 10 June 2009
A fit, 57-year-old man admitted with chest pain and haemoptysis turned out to have a primary tumour in the left lung.
In this 57-year-old Caucasian man, the diagnosis followed a computed tomography scan and histopathological evidence gained post-resection. The biopsy showed a uniform, spindle shape with focal pleomorphism which was suggestive of lung carcinosarcoma.
The authors report this case in literature and discuss how a rare malignant tumour can be found in those presenting with trivial chest symptoms.
The description of lung carcinosarcoma was developed in the early 20th century. It is a rare tumour, accounting for 0.3% of primary lung malignancy. The diagnosis is made through histopathological evidence. The patients presenting with this commonly undergo resection.
Discussion and conclusion
This is a rare malignant tumour which has a mixture of carcinoma and sarcoma consisting of differentiated mesenchymal elements . Regional and distant metastases are infrequent . The peak age for development is in the 5th to the 7th decade of life  and there is greater preponderance in men. Final diagnosis is attainable through histological examination combined with the use of different methods, including monoclonal antibody reactions. Expression of cytokeratin and vimentin confirm the diagnosis of the tumour. This usually produces endobronchial irritation and occlusion and the location explains the symptom. Radical tumour resection and post-operative adjuvant chemotherapy are the best treatments.
Review of current literature
Lung carcinosarcoma is a rare malignancy with a poor prognosis. It accounts for 0.3 % of pulmonary malignancies [4, 5] and it is divided into endobronchial (squamous type) and peripheral (glandular type) categories. There are strong associations with smoking and asbestosis. In the endobronchial type, coughing and blood-tinged sputum usually occur; peripheral tumours are asymptomatic. WHO has added the criterion that pulmonary carcinosarcoma should show differentiation of mesenchymal components into specific tissues. Immunohistochemical differential diagnosis of sarcomatoid carcinoma of the airway in the tumour type leiomyosarcoma is: vimentin +ve, leu-7 antigen +ve, collagen type IV +ve, desmin +ve, smooth-muscle actin +ve .
For patients with pulmonary carcinosarcoma, the treatment of choice with a clear margin is complete resection . The rate of reversibility ranged from 87-93 % . Adjuvant or neoadjuvant therapy can be considered in selected cases.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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