PULMONARY SARCOMATOID CARCINOMA: A CASE REPORT AND REVIEW OF LITERATURE

Abstract

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pulmonary sarcomatoid carcinomas are a rare subtype of poorly differentiated non-small cell lung cancer that accounts for less than 1 percent of primary lung malignancies. This case highlights the clinical presentation & diagnostic evaluation undertaken to identify this rare lung cancer. CASE PRESENTATION: A 77-year-old male with a medical history of tobacco abuse, hypertension & mutism was evaluated for pleuritic chest pain, cough and subjective fevers. Initial vitals were stable and pulmonary examination revealed focal expiratory wheezes auscultated on the right anterior chest with a prolonged expiratory phase throughout. CXR demonstrated a mass-like opacity in the inferior right hilum and the patient was treated with antibiotics for presumed community-acquired pneumonia. Chest CT was obtained due to persistent symptoms which showed a right hilar mass encasing the right pulmonary artery with calcific mediastinal lymphadenopathy. Bronchoscopy with endobronchial ultrasound was performed and samples for cytology were taken from the culprit endobronchial lesion. Lymph node surveillance revealed enlarged left paratracheal, right paratracheal & right hilar lymph nodes from which FNA samples were taken, respectively. Rapid onsite pathological evaluation demonstrated the presence of atypical cells and ultimately revealed sarcomatoid carcinoma. Oncology, radiation oncology, and palliative care were consulted. After a lengthy discussion concerning the treatment options, the patient & family elected to transition to comfort care. The patient was discharged home with hospice. DISCUSSION: Pulmonary sarcomatoid carcinoma is a rare non-small cell carcinoma accounting for approximately 0.1-0.4% of all primary pulmonary malignancies. The disease has a predilection for older males with a prolonged smoking history. Morphologically, sarcomatoid carcinoma is a heterogeneous group of neoplasms that originate from epithelial & mesenchymal tissue containing intermingled elements of carcinoma & sarcoma. There are five recognized subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma & pulmonary blastoma. Given the immense histological variability, a pathologic diagnosis frequently requires a generous tissue sample and can often pose a diagnostic challenge. The clinical course is aggressive with early metastasis rendering the overall prognosis is poor despite therapy. Surgical resection offers the best therapeutic option in early disease and remains the standard of care. Targeted therapies & immunotherapy remain a promising option, but additional research & clinical experience is needed in this patient population. CONCLUSIONS: This case highlights the clinical presentation & diagnostic evaluation undertaken to identify sarcomatoid carcinoma, a rare and aggressive lung cancer with heterogeneous pathology & limited response to traditional therapy. REFERENCE #1: Rajdev K, Siddiqui AH, Ibrahim U, Agarwal S, Ding J, Chalhoub M. Sarcomatoid Carcinoma of the Lung Presenting as Localized Bronchiectasis: A Case Report and Review of Literature. Respir Med Case Rep. 2018;24:143-146. Published 2018 May 17. doi:10.1016/j.rmcr.2018.05.016 REFERENCE #2: Shen XY, Lin ZF, Lin Q, et al. Pulmonary sarcomatoid carcinoma: a case report. Contemp Oncol (Pozn). 2013;17(2):210-213. doi:10.5114/wo.2013.34375 DISCLOSURES: No relevant relationships by Kari McCoy, source=Web Response No relevant relationships by Caroline Mears, source=Web Response No relevant relationships by Xian Qiao, source=Web Response