Sarcomatoid Carcinoma of the Lung Presenting as Localized Bronchiectasis: A Case Report and Review of Literature

Case Report: Pulmonary sarcomatoid carcinoma in a female patient from Nepal

Sarcomatoid carcinoma of the lung is an uncommon subtype of non-small-cell lung cancer (NSCLC). Even in the early stages, pulmonary sarcomatoid carcinoma (PSC) has a dismal prognosis when compared to other kinds of NSCLC with a mean survival of 9–12 months and a five-year survival rate of around 20%. We present the case of a 68-year-old woman with a two-month history of shortness of breath and cough. Initial computed tomography (CT) scan showed features of interstitial lung disease with chronic obstructive airway changes. After 34 months, the patient’s condition worsened with newer complaints of sore throat and hemoptysis. A repeat CT scan showed a ∼49x38x59mm size lesion in the superior segment of the left lower lobe. A core needle biopsy was performed, which revealed tumor cells consisting of irregular tubules and sarcomatoid components. The patient was started on chemotherapy. Unfortunately, she succumbed to her disease. Our case highlights the aggressiveness of PSC.

Pulmonary sarcomatoid carcinoma: progress, treatment and expectations

Pulmonary sarcomatoid carcinoma (PSC) is a unique, highly invasive pulmonary malignancy with a poor prognosis, representing 0.1-0.4% of all malignant lung tumors. Because of its highly aggressive character and propensity for frequent metastasis, PSC shows low response rates to traditional treatments such as chemotherapy, radiotherapy, and neoadjuvant therapy. In recent years, considerable progress has been made in gene sequencing, targeted therapies, and immunotherapies. One of the most promising treatment approaches is the selection of mono-targeted or multi-targeted drugs according to tumor gene-mutation sites, such as epidermal growth factor receptor or vascular endothelial growth factor receptor 2 (EGFR/VEGFR2), anaplastic lymphoma kinase (ALK), and others. Another approach is the activation of therapeutic anti-tumor immunity via pathways including programmed cell-death protein-1/programmed cell-death ligand-1 (PD-1/PD-L1), which has been used in individual cases. In this review, we will introduce the clinicopathologic features, molecular typing, and traditional treatments. We will also review the biological characteristics and the latest therapies for PSC. These novel therapies show promise in the management of PSC, and the outcomes of investigative trials will hopefully reveal a variety of treatment options for patients with PSC.

Perioperative change in neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in patients with completely resected primary pulmonary sarcomatoid carcinoma

Background

There has been controversy regarding prognostic factors for surgically resected primary pulmonary sarcomatoid carcinoma (PSC). Recently, several studies have shown that neutrophil-to-lymphocyte ratio (NLR) was a prognostic factor for various types of cancers from multiple organs. Therefore, we performed this study to evaluate whether NLR is related to prognosis after complete surgical resection of primary PSC.

Methods

From Oct. 2003 to Sep. 2015, a total of 50 patients underwent surgical resection for primary PSC. After excluding patients with any history of other malignancy and incompletely resected cases, a total of 37 patients were included, and data were retrospectively collected and analyzed. Change in postoperative NLR and the initial NLR (ΔNLR) was calculated from the perioperative complete blood count (CBC) results.

Results

Mean age of the cohort was 62.2±1.9 years, and 31 patients (83.8%) were male. Twenty patients (54.1%) were revealed as pN0. Overall 5-year survival rate was 50.3%. Seventeen patients (45.9%) had locoregional or distant metastases. Univariate survival analysis revealed age >70, ΔNLR >17 as risk factors for overall survival (P=0.009, 0.005) and disease-free survival (P=0.036, 0.018). Multivariate Cox-regression analysis revealed age >70 and ΔNLR >17 as independent risk factors for overall survival and ΔNLR >17 as the only independent risk factor for the disease-free survival.

Conclusions

In patients with completely resected primary PSC, perioperative ΔNLR had a significant effect on the overall survival and disease-free survival. Older age was also an independent risk factor for overall survival.