Could spindle cell lung carcinoma be considered and treated as sarcoma, according to its clinical course, morphology, immunophenotype and genetic finding?

Pulmonary sarcomatoid carcinoma: A rare case report, diagnostic dilemma and review of literature

RATIONALE

Pulmonary sarcomatoid carcinoma (PSC), a rare tumor, comprises 0.1% to 0.4% of all malignant lung tumors. Given the rarity of PSC, its clinical course, therapeutic guidelines, and patient outcomes remain largely unknown. Therefore, it is imperative to alert clinicians to this extremely rare and instructive early-onset cancer.

PATIENT CONCERNS

This report describes a 28-year-old woman with PSC, who was initially misdiagnosed with Whipple's disease. A conclusive diagnosis of PSC was made following careful clinical examination, imaging, and histopathological evaluation of the patient's biopsy sample. Radiological imaging revealed multiple nodules and mass formations in the left upper lobe of the patient's lung, with the largest measuring of 5.4 × 3.2 cm.

DIAGNOSIS

Histopathological examination indicated the presence of a malignant neoplasm associated with necrosis suggestive of sarcoma, which was pathologically staged as cT4N1M1.

INTERVENTIONS AND OUTCOMES

A regimen of doxorubicin and ifosfamide was administered therapeutically, resulting in a stable disease state.

LESSONS

The rarity and tumor origin challenge the diagnosis, which emphasizes the imperative role of histological examination, immunohistochemistry, and flow cytometry in achieving an accurate diagnosis. This report summarizes the existing publications to provide a comprehensive overview of PSC, including its clinical manifestations, radiographic imaging, pathologic features, diagnostic challenges, treatment strategies, and prognosis, and aims to improve the understanding of PSC.

Pulmonary spindle cell carcinoma with unusual morphology: A rare case report and review of the literature

RATIONALE

Pulmonary spindle cell carcinoma (PSCC) is a highly malignant carcinoma that often exhibits the histopathological characteristic of cell pleomorphism.

PATIENT CONCERNS

Here, we report a PSCC case in a 59-year-old woman with multiple metastases. The pathological manifestation of this case did not show high-grade pleomorphism or atypia, and was easily mimicked by other borderline or low-grade malignant tumors such as an inflammatory myofibroblastic tumor (IMT).

DIAGNOSES

Based on the results of immunohistochemistry and fluorescence in situ hybridization after the operation, IMT was ruled out, and PSCC was confirmed.

INTERVENTIONS

Resection of the right middle lobe and dissection of the lymph nodes were performed. The patient was given 2 cycles of chemotherapy with cisplatin and 1 cycle of radiotherapy after the operation.

OUTCOMES

Metastatic lesions in the left kidney, the right lung, the first thoracic vertebrae, the retroperitoneal lymph nodes, and the mediastinal lymph nodes were identified by positron emission tomography/computed tomography 4 months after the operation, and the patient died 2 months later.

LESSONS

PSCC is a highly malignant carcinoma, but it rarely shows a low-grade malignant histological morphology. So, efforts should be focused on differentiating it from other borderline or low malignant tumors (such as IMT) to avoid misdiagnosis.

An Autopsy Case of Rapidly Progressing Spindle Cell Carcinoma of the Lung Accompanied with Intratumor Hemorrhage

Patient: Male, 74

Final Diagnosis: Spindle cell carcinoma of the lung

Symptoms: —

Medication: Pemetrexed • carboplatin

Clinical Procedure: Biopsy and autopsy

Specialty: Oncology