Primary pulmonary sarcomatoid carcinoma: A case series

Rationale Pulmonary sarcomatoid carcinoma is an uncommon histologic subtype of non-small cell lung cancer (NSCLC), composed of carcinomatous and sarcomatous cellular components. The diagnosis depends on morphologic, histological and immunohistochemical findings. Due to its rarity, there are no standard treatment guidelines for this aggressive malignancy. Method We retrospectively re-examined 2029 NSCLC samples stored in a university hospital during 12-year period to identify cases of sarcomatoid carcinoma. We analyzed incidence, risk factors, clinical features, image characters, immunohistochemical features, treatment and prognosis. Result We identified only 8 cases (5 males and 3 females) of sarcomatoid carcinoma, accounting for 0.4% of NSCLC. The patients9 age ranged from 43 to 76 years old. None had a remarkable medical or family history. The initial presentation included productive cough, hemoptysis, and localized chest pain. All had a high level of serum tissue polypeptide antigen initially and presented with peripheral nodular opacity or mass radiographically. Microscopically, 5 cases were classified as pleomorphic carcinoma and the other 3 were classified as spindle cell carcinoma. The clinical course was aggressive, and all patients had distal metastases at initial diagnosis, including bone, brain and liver. The mean (± SD) follow-up period was 19.6 ± 0.5 months. The 5-year overall survival rate was 12.5%. Conclusion Primary pulmonary sarcomatoid carcinoma is a rare but aggressive malignancy. We identified eight cases of pulmonary sarcomatoid carcinoma from 2214 lung cancer samples in our hospital during a 12-year period. Accurate and timely diagnosis and proper management remains the key for better patient outcome.