A Rare Case of Sarcomatoid Carcinoma of the Lung with Spine Metastasis, Including a Literature Review

Metastatic sarcomatoid carcinoma to bone

BACKGROUND AND OBJECTIVES

Distinguishing sarcomatoid carcinoma from primary sarcoma is clinically important. We sought to characterize metastatic sarcomatoid bone disease and its management.

METHODS

We analyzed the characteristics of all cases of sarcomatoid carcinoma to bone at a single institution from 2001 to 2021, excluding patients with nonosseous metastases. Survival was evaluated using the Kaplan-Meier method.

RESULTS

We identified 15 cases of metastatic sarcomatoid carcinoma to bone. In seven cases the primary cancer was unknown at presentation. Renal cell carcinoma was suspected or confirmed in nine cases. Nine patients presented with pathologic fracture and two with concomitant visceral metastases. All patients underwent image-guided core needle or open biopsy. Ten required surgery for discrete osseous metastases; in four cases definitive surgery was delayed (median delay, 19 days) due to inability to rule out sarcoma with frozen section. No patients required reoperation or had construct failure. Thirteen died of disease; median survival was 17.5 months (interquartile range, 6.2-25.1).

CONCLUSIONS

Metastatic sarcomatoid carcinoma is a clinically challenging entity. Multidisciplinary input and communication are key to identifying the primary carcinoma, locating osseous metastases, and defining an operative fixation that will survive the remainder of the patient's life.

ARID1A mutations in lung cancer: biology, prognostic role, and therapeutic implications

Mutations in the AT-interacting domain-rich protein 1A (ARID1A) gene, a critical component of the switch/sucrose nonfermentable (SWI/SNF) complex, are frequently found in most human cancers. Approximately 5-10% of lung cancers carry ARID1A mutations. ARID1A loss in lung cancer correlates with clinicopathological features and poor prognosis. Co-mutation of ARID1A and epidermal growth factor receptor (EGFR) results in the limited efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) but increases the clinical benefit of immune checkpoint inhibitors (ICIs). ARID1A gene mutation plays a role in cell cycle regulation, metabolic reprogramming, and epithelial-mesenchymal transition. We present the first comprehensive review of the relationship between ARID1A gene mutations and lung cancer and discuss the potential of ARID1A as a new molecular target.

A Rare Presentation of Sarcomatoid Carcinoma of Duodenum: A Case Report

Sarcomatoid tumors are very rare biphasic tumors characterized by a mixture of malignant epithelial and mesenchymal cells that have been usually identified in the lungs with other documented cases in skin, bone, thyroid gland, salivary glands, breast, and genitourinary and gastrointestinal systems. They have an incidence estimated to be 0.5 to 0.8 per 100 000 per year. Three classic features include the presence of a genuine sarcomatous component, no transitional zone between carcinomatous and sarcomatous components, and immunohistochemistry of the sarcomatous component that is positive for mesenchymal markers and negative for epithelial markers. Sarcomatoid carcinoma of the gastrointestinal tract is rare but more commonly found within the stomach, gallbladder, and esophagus. Small bowel involvement is very rare.

Pulmonary sarcomatoid carcinoma mimicking pleural mesothelioma: A case report

INTRODUCTION

Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare biphasic tumor characterized by a mixture of malignant epithelial and mesenchymal cells. Owing to the rarity, as well as the lack of typical manifestations and imaging signs, the rate of misdiagnosis is high. Herein, we present a case of PSC misdiagnosed as pleural mesothelioma in a 59-year-old man.

PATIENT CONCERNS

A 59-year-old man presented with recurrent coughing, fever, and chest pain.

DIAGNOSIS

Chest computed tomography showed 2 large and dense masses involving the inferior lobes of right lung, along with slight irregular pleural thickening and a small amount of effusion.

INTERVENTIONS

Chest computed tomography-guided tumor biopsy was performed. PSC was confirmed based on histopathology and immunohistochemistry. The patient refused treatment due to economic reasons.

OUTCOMES

The patient developed adrenal, multiple lung and brain metastasis. The overall survival time was 11 months.

CONCLUSIONS

PSC, despite its rarity, should be considered in the differential diagnosis of lung cancer. Besides, biopsy, histopathology, and specific immunohistochemical staining of larger tissue specimens can be contributing to the accurate diagnosis of PSC.

Pulmonary Pleomorphic Carcinoma Mimicking Primary Sarcoma of the Neck: A Case Report and Literature Review

We describe our challenge in diagnosing an unusual and rapidly progressing case of pulmonary pleomorphic carcinoma (PPC)—a rare, poorly differentiated, or undifferentiated non-small-cell carcinoma that can metastasize locally or distantly and has a poor prognosis. Our patient was an elderly man with a one-month history of abdominal pain, anorexia, and weight loss, diagnosed with atrophic gastritis via endoscopy, and treated medically without improvement. A week later, this patient developed pain in the head, neck, and shoulder area, and further examination revealed a thickening of his left neck and shoulder, with no palpable lymph nodes. Computed tomography (CT) of the neck, chest, and abdomen led us to believe that we might be dealing with primary sarcoma of the neck since no lung mass was evident. Further investigation could not be performed because the patient’s status deteriorated rapidly. An autopsy revealed that soft tissue in the left neck and the mesentery was invaded by poorly differentiated polymorphic malignant cells, which were also seen in the lung lesion. Immunohistochemically, these malignant cells were all positive for AE1/AE3, CAM5.2, TTF-1, Napsin-A, and Vimentin. The cells were also positive for programmed death-ligand 1 staining with a low level of tumor proportion score (over 1%). The final diagnosis was PPC with metastases to soft tissues in the left neck and the mesentery. A review of previous case reports of PPC revealed that soft tissue is an uncommon site for metastasis, and that our CT findings were rather unusual. We hereby present our case and review of published case reports, with the hope that an awareness of the heterogeneous features of PPC could prompt timely biopsy and histological diagnosis.

Sarcomatoid carcinoma of the lung

Sarcomatoid carcinoma (SC) of the lung is a rare histological subtype of nonsmall cell lung cancer and comprises a diagnostically and therapeutically challenging group of tumors. We report a patient of SC of the lung in an elderly patient who presented with a lung mass. Computed tomography-guided biopsy of the lung mass was done, which clinched the diagnosis. We present this case because of the rarity of this histological subtype and to expand understanding regarding this rare cancer.

Resected case of stage IV pleomorphic carcinoma of the lung with long-term survival

Background

No established treatments for pulmonary pleomorphic carcinoma exist because of its rarity, and the prognosis is poorer than that of other non-small cell lung cancers.

Case report

We present a case of stage IV pleomorphic carcinoma; the patient was a 66-year-old male. He was referred to our hospital because of a right adrenal hemorrhage and a lung tumor. A systemic examination revealed that the lung tumor was a primary lung cancer and that the adrenal hemorrhage was due to a metastatic cancer. We performed an adrenalectomy and resection of the lung tumor and obtained a diagnosis of pleomorphic carcinoma with adrenal metastasis. The patient has remained recurrence-free for 6 years since the surgery.

Conclusions

We report a patient with stage IV pleomorphic carcinoma of the lung and an oligometastasis in whom a complete resection enabled a good outcome. Additional reports are needed to clarify definite prognostic factors and the optimal treatment for pleomorphic carcinoma.

[Current Status of Diagnosis and Treatment of Pulmonary Sarcomatoid Carcinoma]

Pulmonary sarcomatoid carcinoma (PSC) is a rare, poorly differentiated, subtype of non-small cell lung carcinoma (NSCLC) and constitutes approximately 0.1% to 0.5% of all lung malignancies. PSC can be divided into five subtypes based on the 2015 World Health Organization (WHO) classification of lung tumors: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma, and pulmonary blastoma. Some imaging characteristics can be found for PSC although no special symptoms. The accurate pathological diagnosis of PSC can be a significant challenge, which depends on pathology and immunohistochemistry. PSC should be managed similar to other NSCLC, surgical resection is the standard management for early stage cases, moreover, multimodal treatment should be considered. However, PSC is insensitive to radiotherapy and chemotherapy, and has high rate of local and metastatic recurrence and poor prognosis. With the development of molecular pathology, targeted therapy and immunotherapy may have broad prospects.
.