Pulmonary carcinosarcoma initially presenting as invasive aspergillosis: a case report of previously unreported combination
TL;DR: A case of primary carcinosarcoma of the lung concurrently occurring with invasive pulmonary aspergillosis in a 66-year old patient is described.
Abstract: Carcinosarcoma of the lung is a malignant tumor composed of a mixture of carcinoma and sarcoma elements. The carcinomatous component is most commonly squamous followed by adenocarcinoma. The sarcomatous component commonly comprises the bulk of the tumor and shows poorly differentiated spindle cell features. Foci of differentiated sarcomatous elements such as chondrosarcoma and osteosarcoma may be seen. Aspergillus pneumonia is the most common form of invasive aspergillosis and occurs mainly in patients with malignancy, immunocompromizing or debilitating diseases. Patients with Aspergillus pneumonia present with fever, cough, chest pain and occasionally hemoptysis. Tissue examination is the most reliable method for diagnosis, and mortality rate is high. We describe a case of primary carcinosarcoma of the lung concurrently occurring with invasive pulmonary aspergillosis in a 66-year old patient.
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TL;DR: A case of pulmonary carcinosarcoma in a 66 years male who presented with cough, chest pain on exertion, anorexia and weight loss is reported, and poorly differentiated non-small cell carcinoma is revealed.
Abstract: Primary carcinosarcoma of the lung is exceedingly rare. It is described as malignancy composed of a mixture of carcinoma and sarcoma elements. The sarcomatous element is usually spindle cell but may contain cartilage, bone or skeletal muscle. We report a case of pulmonary carcinosarcoma in a 66 years male who presented with cough, chest pain on exertion, anorexia and weight loss. Brush cytology revealed poorly differentiated non-small cell carcinoma. Histopathological examination showed proliferation of malignant spindle cells containing bone and malignant cartilage admixed with areas of keratinized squamous cells with few foci of ill-defined glandular structure. On immunohistochemistry, carcinomatous component of tumor showed positivity for cytokeratin AE1/AE3 and spindle cell component were positive for vimentin. These findings led to diagnosis of carcinosarcoma. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 419-421 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7873
03 Mar 2012
TL;DR: In conclusion, imaging of fibrous lesions of the thorax: radiologic-pathologic correlation in ERC 2012/C-2036 shows clear associations with cancerous deposits in women and suggests the need for further research into the etiology of these deposits.
Abstract: Poster: "ECR 2012 / C-2036 / Imaging of fibrous lesions of the thorax: radiologic-pathologic correlation " by: "M. I. Garcia Gomez Muriel, C. F. Gomez Barbosa, L. Gorospe , A. Fernandez Orue, M. Navarro Fernandez-Hidalgo, H. Pian ; Madrid/ES"
TL;DR: A Caucasian woman who presented with recurrent haemoptysis and a right upper lobe cavitary lesion on CT scan and underwent adjuvant chemotherapy after her lobectomy with recurrence and metastasis to her stomach and pancreas is presented.
Abstract: Pleomorphic carcinoma of the lung is a rare form of malignancy that can present similarly to other necrotising cavitary lung diseases. We present a case of a Caucasian woman who presented with recurrent haemoptysis and a right upper lobe cavitary lesion on CT scan. She underwent selective embolisation of the right bronchial artery by interventional radiology to control her haemoptysis. Positron emission tomography/CT scan was performed which showed significant fluorodeoxyglucose uptake in the right upper lobe cavitary lesion. There was a discussion among her providers about the aetiology of this lesion including infection and malignancy. Cultures from bronchoalveolar lavage and blood were negative for infection as the patient underwent right upper lobectomy which showed invasive sarcomatoid pleomorphic carcinoma with a minor component of acinar adenocarcinoma. She was diagnosed with stage IB (T2aN0M0) sarcomatoid pleomorphic carcinoma and underwent adjuvant chemotherapy after her lobectomy with recurrence and metastasis to her stomach and pancreas.
TL;DR: A case of advanced stage pulmonary carcinosarcoma in a 83-year-old patient, treated with immunotherapy with good response lasted for more than one year is reported.
Abstract: Pulmonary Carcinosarcoma is an uncommon malignant biphasic tumor that accounts for less than 1% of all lung cancers. It is defined by coexisting histologic elements of carcinomatous and sarcomatous components. We report a case of advanced stage pulmonary carcinosarcoma in a 83-year-old patient, treated with immunotherapy with good response lasted for more than one year.
Cites background from "Pulmonary carcinosarcoma initially ..."
...It is included in a group of poorly differentiated non-small cell lung carcinomas that contain a component of sarcomatoid differentiation, so called sarcomatoid carcinoma [2, 3, 5, 6]....
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...3%) of all primary pulmonary neoplasms [1-4, 6]....
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TL;DR: The detection of mucosal changes of airway by using flexible bronchoscopy has great value in the diagnosis of inhalational injury without any complications.
Abstract: BACKGROUND: As acute inhalational injury is an uncommon presentation to most institutions, a standard approach to its assessment and management, especially using flexible bronchoscopy, has not received significant attention. METHODS: The objective of this study is to evaluate the mucosal changes in airway by using flexible bronchoscopy as part of the evaluation and management of patients with inhalational lung injury. Twenty-three cases of inhalational lung injury were treated in our two hospitals after a fire in a plastic go down affected people in surrounding residential houses. The twenty cases that underwent bronchoscopy as part of their management are included in this analysis. After admission, the first bronchoscopy was conducted within 18-72 hours post inhalational injury. G2-level patients were reexamined 24 hours after the first bronchoscopy, while G1-level patients were reexamined 72 hours later. Subsequently, all patients were re-examined every 2-3 days until recovered or until only tunica mucosa bronchi congestion was identified by bronchoscopy. RESULTS: Twenty patients had airway injury diagnosed by bronchoscopy including burns to the larynx and glottis or large airways. Bronchoscopic classification of the inhalation injury was performed, identifying 12 cases of grade G1 changes and 8 cases of grade G2. The airway injury in the 12 cases of grade G1 patients demonstrated recovery in 2-8 days, in the airway injury of the 8 cases of grade G2 patients had a prolonged recovery with airway injury improving in 6-21 days averaged. The difference in recovery time between the two groups was significant (P <0.05). CONCLUSIONS: The detection of mucosal changes of airway by using flexible bronchoscopy has great value in the diagnosis of inhalational injury without any complications.
Cites background from "Pulmonary carcinosarcoma initially ..."
...[1-4] As acute inhalational injury is an uncommon presentation to most institutions, a standard approach to its assessment and management, especially using flexible bronchoscopy, has not received significant attention....
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References
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TL;DR: A set of research-oriented definitions for the IFIs most often seen and studied in immunocompromised patients with cancer is proposed and three levels of probability are proposed: "proven," "probable," and "possible."
Abstract: During the past several decades, there has been a steady increase in the frequency of opportunistic invasive fungal infections (IFIs) in immunocompromised patients. However, there is substantial controversy concerning optimal diagnostic criteria for these IFIs. Therefore, members of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for IFIs for clinical research. On the basis of a review of literature and an international consensus, a set of research-oriented definitions for the IFIs most often seen and studied in immunocompromised patients with cancer is proposed. Three levels of probability are proposed: "proven," "probable," and "possible." The definitions are intended for use in the context of clinical and/or epidemiological research, not for clinical decision making.
2,314 citations
"Pulmonary carcinosarcoma initially ..." refers methods in this paper
...In retrospective microbiology studies of patients with “proven” and “probable” invasive aspergillosis based on the European Organization for Research and Treatment of Cancer, and the Mycosis Study Group of the National Institute of Allergy and Infectious Diseases criteria between 1993-2003, only 1 of a total of 13 patients who met the criteria for invasive aspergillosis was found to have lung cancer [10-12]....
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Book•
20 Sep 2004
TL;DR: This book will not become a unity of the way for you to get amazing benefits at all, but, it will serve something that will let you get the best time and moment to spend for reading the book.
Abstract: It sounds good when knowing the pathology and genetics of tumours of the lung pleura thymus and heart in this website. This is one of the books that many people looking for. In the past, many people ask about this book as their favourite book to read and collect. And now, we present hat you need quickly. It seems to be so happy to offer you this famous book. It will not become a unity of the way for you to get amazing benefits at all. But, it will serve something that will let you get the best time and moment to spend for reading the book.
1,858 citations
TL;DR: The incidence of aspergillosis is increasing and should be considered in the setting of progressive pulmonary infiltrates in leukemic and other heavily immunosuppressed patients who respond poorly to antibacterial therapy.
504 citations
"Pulmonary carcinosarcoma initially ..." refers result in this paper
...The typical tissue reaction in aspergillus pneumonia is known to be hemorrhagic infarction with a sparse inflammatory infiltrate [13], and our case revealed similar features....
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TL;DR: Kohno et al. as discussed by the authors retrospectively reviewed 385 cases of suspected or documented aspergillosis that occurred during a 9-year period and identified 289 episodes that fulfilled the criteria for possible, probable, or proven invasive Aspergillus active antifungal drug treatment.
Abstract: 7 Laboratoire d'Epidemiologie et de SantePublique, Faculted e Medecine, UniversiteLouis Pasteur, Strasbourg, France (See the editorial commentary by Kohno on pages XXX-XX) Background. Invasive aspergillosis is associated with high death rates. Factors associated with increased mor- tality have not yet been identified in a large population of patients with various underlying conditions. Methods. We retrospectively reviewed 385 cases of suspected or documented aspergillosis that occurred during a 9-year period. We identified 289 episodes that fulfilled the criteria for possible, probable, or proven invasive aspergillosis according to the international definition criteria and that was treated with an anti-Aspergillus active antifungal drug. Clinical and microbiological variables were analyzed for their effects on overall and attributable mortality. Significant variables in univariate analysis were introduced into a multivariate Cox model. Results. Twelve-week overall and disease-specific survival rates were 52.2% (95% confidence interval, 46.5%- 57.9%) and 59.8% (95% confidence interval, 54.0%-65.4%), respectively. Receipt of allogeneic hematopoietic stem cell or solid-organ transplant, progression of underlying malignancy, prior respiratory disease, receipt of corti- costeroid therapy, renal impairment, low monocyte counts, disseminated aspergillosis, diffuse pulmonary lesions, pleural effusion, and proven or probable (as opposed to possible) aspergillosis are predictors of increased overall mortality. Similar factors are also predictors of increased attributable mortality, with the following exceptions: pleural effusion and low monocyte counts have no impact, whereas neutropenia is associated with a higher attributable mortality. Conclusions. Identification of predictors of death helps in the identification of patients who could benefit from more-aggressive therapeutic strategies. Initiation of therapy at the stage of possible infection improves out- come, and this finding calls for the development of efficient preemptive strategies to fill the gap between empirical and directed therapy.
306 citations
"Pulmonary carcinosarcoma initially ..." refers background or methods in this paper
...In retrospective microbiology studies of patients with “proven” and “probable” invasive aspergillosis based on the European Organization for Research and Treatment of Cancer, and the Mycosis Study Group of the National Institute of Allergy and Infectious Diseases criteria between 1993-2003, only 1 of a total of 13 patients who met the criteria for invasive aspergillosis was found to have lung cancer [10-12]....
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...renal impairment, low monocyte counts, disseminated aspergillosis, diffuse pulmonary lesions, pleural effusion, and proven or probable aspergillosis [11]....
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TL;DR: There is significant interest in combination antifungal therapy pairing an echinocandin with either an azole or amphotericin B formulation as therapy for invasive aspergillosis, and there has been an increased understanding of the immunology of Aspergillus infection.
Abstract: Filamentous fungi (moulds) are ubiquitous soil inhabitants whose conidia are inhaled into the respiratory tract, where they may cause life-threatening infections. Among these infections is invasive aspergillosis, which is a major cause of morbidity and mortality in the severely immunocompromised. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, hematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease. Invasive aspergillosis most commonly involves the sinopulmonary tract reflecting inhalation as the principal portal of entry. Chest computed tomography scans and new non-culture-based assays such as antigen detection and polymerase chain reaction may facilitate the early diagnosis of invasive aspergillosis, but have limitations. Reflecting an important unmet need, there has been a significant expansion in the antifungal armamentarium. The second-generation triazole, voriconazole, was superior to conventional amphotericin B as primary therapy for invasive aspergillosis, and is the new standard of care for this infection. There is significant interest in combination antifungal therapy pairing an echinocandin with either an azole or amphotericin B formulation as therapy for invasive aspergillosis. In addition, there has been an increased understanding of the immunology of Aspergillus infection, paving the way to novel immune augmentation strategies in animal models that merit evaluation in phase I clinic trials.
303 citations
"Pulmonary carcinosarcoma initially ..." refers background in this paper
...It most often presents as aspergillus pneumonia and almost always involves immunoecompromized or debilitated patients with underlying malignancy [9]....
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...Risk factors include prolonged and severe neutropenia, hematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease [9]....
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