Pulmonary carcinosarcoma: radiologic and pathologic findings in three patients.
01 Sep 1997-American Journal of Roentgenology (American Public Health Association)-Vol. 169, Iss: 3, pp 691-694
TL;DR: Three patients with pulmonary carcinosarcoma had tumors that measured 9-14 cm in diameter, had inhomogeneous contrast enhancement, and in two cases had invaded the mediastinum or chest wall extensively.
Abstract: OBJECTIVE: The purpose of this study was to describe the radiologic and pathologic features of pulmonary carcinosarcoma in three patients. CONCLUSION: The tumors measured 9-14 cm in diameter, had inhomogeneous contrast enhancement, and in two cases had invaded the mediastinum or chest wall extensively. Carcinosarcomas are rare tumors that tend to be large, necrotic, enhancing, and locally invasive.
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TL;DR: The histologic differences between these two types of tumor suggest that they may be different entities with similar behavior, but additional studies are warranted to investigate this hypothesis.
Abstract: Carcinosarcoma is a malignant tumor having a mixture of carcinoma and sarcoma containing differentiated mesenchymal elements, such as malignant cartilage, bone, and skeletal muscle. These tumors have been linked histogenetically to pleomorphic carcinomas; it is unclear whether their clinical behavior is significantly different. To investigate this issue, we studied 66 cases of carcinosarcomas of the lung and compared them with cases from a previously published series of pleomorphic carcinomas. Carcinosarcomas show a male-to-female ratio of 7.25:1, with a mean and median age of 65 years. They most often present as solitary masses in the upper lobes and average 7 cm in diameter. Most (62%) were endobronchial or central tumors, whereas 38% were described as peripheral. The most frequent epithelial component was squamous cell carcinoma (46%), followed by adenocarcinoma (31%) and adenosquamous carcinoma (19%), whereas sarcomatous elements most frequently included rhabdomyosarcoma, chondrosarcoma, osteosarcoma, or combinations of these elements. Survival of patients with carcinosarcomas of lung was poor, with a 5-year survival rate of 21.3%. Of several clinical and pathologic parameters, only increased tumor size (with 6 cm as the optimal cutoff point) appeared to be related to reduced survival (p = 0.0195). In comparison with patients with pleomorphic carcinoma, patients with carcinosarcomas had no significant difference in the size of their tumors (p = 1.0), stage at presentation (p = 0.883), location in the lung (p = 0.073), or their overall survival (21.3% vs 15.0%) (p = 0.1038). A significantly greater proportion of patients with carcinosarcoma had squamous cell (p = 0.004) or adenosquamous (p = 0.016) carcinoma, whereas patients who had pleomorphic carcinoma showed a significantly greater frequency of adenocarcinoma (p = 0.029) and large cell carcinoma. The histologic differences between these two types of tumor suggest that they may be different entities with similar behavior, but additional studies are warranted to investigate this hypothesis.
179 citations
TL;DR: It is shown for the first time, ultrastructurally and immunohistochemically, that the tumor cells in the sarcomatous component of pulmonary carcinosarcomas have features of both epithelial and mesenchymal cells.
Abstract: A case of pulmonary carcinosarcoma in a 68-year-old male patient is reported. The tumor in the resected left upper lobe extended mainly endobronchially, invading the normal bronchial lumina and mucosa. The carcinomatous component consisted of poorly differentiated squamous cell carcinoma and was mainly located in the periphery of the tumor nests. The sarcomatous component consisted of chondrosarcoma and was mainly located in the center of the tumor nests. Tumor cells in the sarcomatous component reacted with anti-S-100 protein antibody and were surrounded with abundant homogeneous extracellular matrix staining positively with Alcian blue. The transition from the carcinomatous component to the sarcomatous component appeared to be very smooth. The tumor cells in both the carcinomatous and sarcomatous components reacted with anti-epithelial membrane antigen antibody. Ultrastructurally, the tumor cells with tonofibrils in the carcinomatous component were apposed and connected to each other by desmosomes. By contrast, in the sarcomatous component, the tumor cells had well-developed and dilated rough endoplasmic reticulum and were arranged loosely in a myxomatous matrix. Some tumor cells in the sarcomatous component had occasional tonofibrils, and were apposed and connected to each other by desmosome-like structures. It is shown for the first time, ultrastructurally and immunohistochemically, that the tumor cells in the sarcomatous component of pulmonary carcinosarcomas have features of both epithelial and mesenchymal cells. It is suggested that the sarcomatous component in the present case is derived from the carcinomatous component.
28 citations
TL;DR: Two cases of carcinosarcoma are reported in a 68-year-old patient and a 78-year old patient explored for lung masses, consisting in adenosquamous carcinoma with osteosarcomA in one case and adenocarcinoma with chondrosarcomas in the other case.
Abstract: 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 two cases of carcinosarcoma in a 68-year-old patient and a 78-year-old patient explored for lung masses. Macroscopically, the resected tumors were 7 and 10 cm in diameter. Histologically, they consisted in adenosquamous carcinoma with osteosarcoma in one case and adenocarcinoma with chondrosarcoma in the other case.
22 citations
Cites background from "Pulmonary carcinosarcoma: radiologi..."
...However, as more cases accumulate, this opinion appears to be true only when the tumor is small (<3 cm) and when no metastases are present (2,8,9)....
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TL;DR: The clinicopathologic features, immunohistochemical phenotype, molecular biological characteristics, and the differential diagnosis of these uncommon neoplasms are discussed.
Abstract: Malignant biphasic tumors of the lungs are rare primary tumors of the bronchopulmonary system These tumors are composed of malignant epithelial and mesenchymal elements and together comprise <2% of all primary pulmonary neoplasms The tumors belonging to this group include pulmonary blastoma, pleuropulmonary blastoma, and carcinosarcoma In this study, the clinicopathologic features, immunohistochemical phenotype, molecular biological characteristics, and the differential diagnosis of these uncommon neoplasms are discussed
22 citations
Cites background from "Pulmonary carcinosarcoma: radiologi..."
...Radiologically, endobronchial carcinosarcomas show features of obstruction, whereas peripheral lesions are characterized by large round parenchymal-based masses; they may present with local invasion into the chest wall, pericardium, or pulmonary vein.(66)...
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References
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TL;DR: Pulmonary resection with curative intent was performed in 15 of 17 patients; however, only 4 patients were alive at 6, 8, 28, and 39 months, respectively, postoperatively, and the median survival was 1 year.
108 citations
87 citations
TL;DR: This report describes a unique case of sarcomatoid carcinoma in a 52-year-old woman in whom the sarcom atous component of the tumor was a rhabdomyosarcoma and the carcinomatous component was an atypical carcinoid.
Abstract: Sarcomatoid carcinomas of the lung are uncommon malignant biphasic tumors composed of carcinomatous and sarcomatous components. The carcinomatous component is usually a squamous carcinoma, and the sarcomatous component usually resembles a fibrosarcoma or a malignant fibrous histiocytoma. The presence of rhabdomyoblastic differentiation in such neoplasms is exceedingly rare, with only seven documented cases. This report describes a unique case of sarcomatoid carcinoma in a 52-year-old woman in whom the sarcomatous component of the tumor was a rhabdomyosarcoma and the carcinomatous component was an atypical carcinoid. The authors know of no previous report of a sarcomatoid carcinoma of the lung in which the carcinomatous component is a carcinoid.
31 citations
24 citations
TL;DR: This case report details the surgical management of a carcinosarcoma in a patient seen with pulmonary osteoarthropathy.
17 citations