Huge carcinosarcoma of lung presenting as an intra-abdominal mass

Abstract

We report a case of huge carcinosarcoma of lung initially presenting as an intra-abdominal mass: treatment with enucleation of the firm sarcomatous component followed by pulmonary resection. A 65-year-old man with mild mental retardation who smoked one pack of cigarettes per day until 1-month before he was admitted to our hospital complaining of a progressively poorer appetite, vomiting and an abdominal mass at the left upper quadrant region. Physical examination revealed a palpable mass over the left upper abdomen with percussion dullness of the lower hemithorax. Chest radiograph revealed a homogeneous mass lesion in the left lower lung field with obliteration of the costophrenic angle. Computed tomography scans of the chest disclosed a huge mass over the left lower thorax and upper abdomen with compression of the heart and shift of the esophagus and descending aorta to the midline. Sono-guided aspiration biopsy cytology revealed squamous cell carcinoma. Surgical intervention with enucleation of the very firm sarcomatous component with fragmentation followed by radical lobectomy. Chemotherapy was planned as adjuvant therapy in the postoperative period, but the patient's family declined it. The patient is currently survived without tumor recurrence 14 months after surgery. Our case revealed a huge tumor not only mediastinal compression but also initial presenting abdominal symptoms. Initially, from the symptoms and nonbiopsy study, we were unable to determine exactly if it was an intrathoracic tumor or an intra-abdominal tumor. This case highlights the importance of remaining clinically vigilant to differentiate an unusual tumor mass, and preoperative tissue proof is warranted.