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Joacquim MA, Bhat N, Kulkarni N, Coup A, Dharmavaram S. Sarcomatoid Carcinoma of the Lung With Gastrointestinal Metastasis Causing Small Intestinal Obstruction: A Rare Case of Acute Surgical Emergency. Cureus 2023; 15:e38414. [PMID: 37273401 PMCID: PMC10233168 DOI: 10.7759/cureus.38414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
Pulmonary sarcomatoid carcinomas (PSCA) are a rare subset of Non-Squamous-Cell Lung Carcinoma (NSCLC), the most common pathological subtype of lung cancers which are the most common malignancy in the world. These rarest of rare tumours may have gastrointestinal metastasis and present as an acute abdominal surgical emergency with bowel obstruction or bleeding, as in our patient, who did not have a diagnosis of lung cancer till then. Use of novel immunohistochemistry markers like thyroid transcription factor-1 (TTF-1) may help diagnose the site of the primary tumour with accuracy in this clinical setting. Further evaluation of these patients with positron emission tomography (PET) scans helps determine the tumour burden and degree of dissemination. The aim of this article is to emphasize this rare presentation which may be unsuspected as a cause of bowel obstruction by surgical teams on the acute surgical take due to its rarity. It is vital that nihilism is avoided in these patients as a subset of these patients can still be offered curative metastectomy and treatment of the primary tumour with reasonable outcomes.
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Affiliation(s)
| | - Nadeem Bhat
- General Surgery, United Lincoln National Health Service (NHS) Trust, Lincoln, GBR
| | | | - Andrew Coup
- Pathology, United Lincoln National Health Service (NHS) Trust, Lincoln, GBR
| | - Sridhar Dharmavaram
- General and Colorectal Surgery, United Lincoln National Health Service (NHS) Trust, Lincoln, GBR
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Devkota A, Paudel A, Sapkota S, Pandit S, Baniya A. Case Report: Pulmonary sarcomatoid carcinoma in a female patient from Nepal. F1000Res 2021; 10:723. [PMID: 35342622 PMCID: PMC8921689 DOI: 10.12688/f1000research.55187.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
| | - Amrit Paudel
- Department of Internal Medicine, Union Memorial Hospital, Baltimore, MD, USA
| | - Simit Sapkota
- Department of Oncology, Civil Service Hospital, Kathmandu, Nepal
| | - Subash Pandit
- Department of Oncology, Civil Service Hospital, Kathmandu, Nepal
| | - Aashish Baniya
- Department of Neurology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Kathmandu, Nepal
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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. [PMID: 29984148 PMCID: PMC6010667 DOI: 10.1016/j.rmcr.2018.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/13/2018] [Accepted: 05/13/2018] [Indexed: 11/17/2022] Open
Abstract
Sarcomatoid carcinoma (SC) of the lung is a rare and aggressive biphasic lung tumor with a 5-year survival of 20%. Early detection and treatment is the only way to improve outcomes in patients with SC of the lung. We present a case of primary SC identified early based on high suspicion. A 56-year-old female with a history of chronic obstructive pulmonary disease (COPD) presented with hemoptysis and exertional dyspnea. Chest X-ray revealed right upper lobe (RUL) opacity and patient was started on antibiotics for pneumonia. Due to the persistence of hemoptysis, a computed tomography scan was performed which showed RUL bronchiectasis with scattered nodular opacities suggestive of an infectious process. The patient underwent bronchoscopy which revealed a pedunculated mass in the RUL biopsy of which was consistent with poorly differentiated SC. Positron-emission tomography scan revealed Flourdeoxyglucose-avid right peri-hilar mass and another nodule in the RUL. The patient was not a surgical candidate because of severe COPD and was started on chemoradiation therapy. SC of the lung can have various presentations and is usually detected at a later stage and hence, difficult to treat. Our case highlights the importance of critical thinking and prompt diagnostic evaluation in high-risk patients with localized bronchiectasis even without an obvious lung mass on imaging.
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Affiliation(s)
- Kartikeya Rajdev
- Department of Medicine, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Abdul Hasan Siddiqui
- Department of Pulmonary/Critical Care, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Uroosa Ibrahim
- Department of Hematology/Oncology, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Shivika Agarwal
- Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, State Highway 16A, Rohtak, Haryana, 124514, India
| | - Juan Ding
- Department of Pathology, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Michel Chalhoub
- Department of Pulmonary/Critical Care, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
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Taira N, Kawabata T, Gabe A, Furugen T, Ichi T, Kushi K, Yohena T, Kawasaki H, Higuchi D, Chibana K, Fujita K, Nakamoto A, Owan I, Kuba M, Ishikawa K. Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis. Oncol Lett 2017; 14:2399-2404. [PMID: 28781676 DOI: 10.3892/ol.2017.6382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/03/2017] [Indexed: 01/19/2023] Open
Abstract
The prevalence of gastrointestinal metastasis of lung cancer is low. The aim of the present study was to analyze the frequency and clinical characteristics of metastases to the gastrointestinal tract by retrospectively assessing the clinical records of 2,066 patients with lung cancer. A total of 7 patients (0.33%) were diagnosed with gastrointestinal metastasis, including 4 patients with adenocarcinoma, 1 patient with large cell carcinoma and 2 patients with pleomorphic carcinoma. Furthermore, 3 of the patients presented with small bowel metastases, 2 with gastric metastases, 1 with large bowel metastasis and 1 with metastasis of the appendix. The mean time between the diagnosis of the lung tumors and the identification of gastrointestinal metastasis was 13.5 months (range, 3-49 months). The mean time between the identification of the gastrointestinal metastasis and mortality was 100.6 days (range, 21-145 days). In conclusion, the prognosis of patients with recurrence in distant organs, including the gastrointestinal tract, may be worse than patients with recurrence in distant organs, excluding the gastrointestinal tract, particularly those with symptomatic gastrointestinal metastasis. Therefore, the presence of clinical gastrointestinal metastasis may be life threatening; comprehensive evaluations are required to detect and monitor gastrointestinal metastasis during follow-up.
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Affiliation(s)
- Naohiro Taira
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Tsutomu Kawabata
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Atsushi Gabe
- Department of General Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Haebaru, Okinawa 9011193, Japan
| | - Tomonori Furugen
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Takaharu Ichi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kazuaki Kushi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Tomofumi Yohena
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Hidenori Kawasaki
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Daisuke Higuchi
- Department of Gastroenterology, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kenji Chibana
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kaori Fujita
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Atsushi Nakamoto
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Isoko Owan
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Mutsuo Kuba
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kiyoshi Ishikawa
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
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Abstract
Pulmonary sarcomatoid carcinomas are a rare group of tumors accounting for about one percent of non-small cell lung carcinoma (NSCLC). In 2015, the World Health Organization classification united under this name all the carcinomas with sarcomatous-like component with spindle cell or giant cell appearance, or associated with a sarcomatous component sometimes heterologous. There are five subtypes: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma and pulmonary blastoma. Clinical characteristics are not specific from the other subtypes of NSCLC. Epithelial to mesenchymal transition pathway may play a key role. Patients, usually tobacco smokers, are frequently symptomatic. Tumors are voluminous more often peripherical than central, with strong fixation on FDG TEP CT. Distant metastases are frequent with atypical visceral locations. These tumors have poorer prognosis than the other NSCLC subtypes because of great aggressivity, and frequent chemoresistance. Here we present pathological description and a review of literature with molecular features in order to better describe these tumors and perhaps introduce new therapeutics.
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Abstract
Pulmonary sarcomatoid carcinomas are a rare group of tumors accounting for about 1 % of non-small cell lung carcinoma (NSCLC). In 2004, World Health Organization classification united under this name all the carcinomas with sarcomatous or sarcomatous-like component with spindle cell or giant cell appearance. There are five subtypes: spindle cell carcinoma, giant cell carcinoma, pleomorphic carcinoma, carcino-sarcoma and pulmonary blastoma. Clinical characteristics are not specific from the others subtypes of NSCLC. Epithelial to mesenchymal transition pathway may play a key role. Patients are frequently symptomatic. Tumors are voluminous more often peripherical than central, with strong fixation on FDG TEP CT. Distant metastasis are frequent with atypical locations such as peritoneal or retroperitoneal sites. These tumors have poorer prognosis than the other NSCLC subtypes because of great aggressivity, and frequent chemoresistance. Here, we present a review of litterature in order to better describe these tumors.
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