Pulmonary Sarcomatoid carcinoma: a surgical diagnosis and prognostic factors

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Published Apr 18, 2019
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Vol. 97 No. 1 (2019): Issue Jan 2019

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Hanène Smadhi
Mohamed Sadok Boudaya
Mahdi Abdannadher
Hajer BenAbdelghaffar
Héla Kamoun
Aida Ayadi
Leila Fekih
Adel Marghli
Mohamed Lamine Megdiche

Abstract

Introduction: Pulmonary Sarcomatoid Carcinoma (PSC) is a rare group of tumors accounting for about 0.4% of non-small cell lung carcinoma (NSCLC). Five subtypes were described:
pleomorphic carcinoma, spindle cell carcinoma, carcinosarcoma, giant cell carcinoma and pulmonary blastoma. The diagnosis is pathological but requires a good quality sampling of the tumor.
Methods: On a series of 1582 patients operated on for lung cancer from 1992 to 2016, 43 patients were retrospectively identified as having been treated surgically for pulmonary
sarcomatoid carcinoma.
Results: The population consisted of 33 males and 10 females with mean age of 55 years.
Imaging findings showed a peripheral mass in the majority of cases (n=29). Careful investigation failed to discover a primitive lesion elsewhere. Six patients received induction therapy for wall involvement. Lobectomy or bilobectomy was performed in 30 patients and pneumonectomy in 11 patients. A wedge resection was performed in one patient and an exploratory thoracotomy in another. In macroscopy, the mean tumor’s size was 5.2 cm (1-17.5cm). The histologic diagnoses were: pleomorphic carcinoma (n=30), carcinosarcoma (n=5), spindle cell carcinoma (n=1), giant cell carcinoma (n=3) and blastoma (n=4). Two patients died within 1 month of surgical complications and 5 died of disease within 17 months. Adjuvant therapy was performed in 6 patients. Recurrence happened in 4 patients within 12 months after operation. Median survival for all patients was 8months.
Conclusions: Resection of primary pulmonary sarcomatoid carcinoma is associated with an acceptable survival rate if the resection is complete. The size of the tumor is the most important prognosis factor. Nevertheless, a carefully follow-up is essential.

Keywords:

lung cancer; Sarcomatoid carcinoma, Surgery, Prognosis

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References

  1. Travis WD, WHO classification of tumors of the lung. Pleura, thymus and heart, 4thedn. IARC 2015;88-94.
  2. Beasley MB, Brambilla E, Travis WD. The 2004 World Health Organization classification of lung tumors. SeminRoentgenol 2005;40:90-7.
  3. Ram R, Saadat P, Peng D, Vadmal M: Case report and literature review: Primary cutaneous carcinosarcoma. Ann Clin Lab Sci, 2005; 35(2): 189-94.
  4. Huang SY, Shen SJ, Li XY: Pulmonary sarcomatoid carcinoma: A clinicopathologic study and prognostic analysis of 51 cases. World J SurgOncol, 2013; 11: 252
  5. Rossi G, Cavazza A, Sturm N, Migaldi M, Facciolongo N, Longo L, et al. Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements: a clinicopathologic and immunohistochemical study of 75 cases. Am J SurgPathol 2003; 27:311-24.
  6. Fishback NF, Travis WD, Moran CA, Guinee Jr. DG, McCarthy WF, Koss MN. Pleomorphic (spindle/giant cell) carcinoma of the lung. A clinicopathologic correlation of 78 cases. Cancer 1994;73:2936-45.
  7. Koss MN, Hochholzer L, O'Leary T. Pulmonary blastomas. Cancer.1991;67:2368-81.
  8. Mochizuki T, Ishii G, Nagai K, Yoshida J, Nishimura M, Mizuno T, et al. Pleomorphic carcinoma of the lung: clinicopathologic characteristics of 70 cases. Am J SurgPathol 2008;32:1727-35.
  9. Bacha EA, Wright CD, Grillo HC, Wain JC, Moncure A, Keel SB, Donahue DM, Mathisen DJ. Surgical treatment of primary pulmonary sarcomas. Eur J CardiothoracSurg 1999;15:456-60.
  10. Park JS, Lee Y, Han J, Kim HK, Choi YS, Kim J et al. Clinicopathologic outcomes of curative resection for sarcomatoid carcinoma of the lung. Oncology 2011;81:206-13.].
  11. Nakajima M, Kasai T, Hashimoto H, Iwata Y, Manabe H. Sarcomatoid carcinoma of the lung: a clinicopathologic study of 37 cases. Cancer 1999;86:608-16.
  12. Travis WD. Sarcomatoid neoplasms of the lung and pleura. Arch Pathol Lab Med 2010;134:1645-58.
  13. Ishida T, Tateishi M, Kaneko S et al: Carcinosarcoma and spindle cell carcinoma of the lung. Clinicopathologic and immunohistochemical studies. J ThoracCardiovascSurg, 1990; 100(6): 844-52].
  14. Venissac N, Pop D, Lassalle S, Berthier F, Hofman P, Mouroux J. Sarcomatoid lung cancer (spindle/giant cells): an aggressive disease? J ThoracCardiovascSurg 2007;134:619-23.
  15. Petrov DB, Vlassov VI, Kalaydjiev GT, Plochev MA, Obretenov ED, Stanoev VI et al. Primary pulmonary sarcomas and carcinosarcomas: postoperative results and comparative survival analysis. Eur J CardiothoracSurg 2003;23:461-6.].
  16. Wick MR, Manivel JC. Primary sarcomas of the lung. In:Williams CJ, Krikorian JG, Green MR, Raghavan D, editors. Textbook of uncommon cancer. Chichester: John Wiley and Sons, 1988:335-81.
  17. Hansen M. Paraneoplastic syndromes and tumor markers for small cell and non-small cell lung cancer. CurrOpinOncol 1990; 2: 345-51.
  18. Janssen JP, Mulder JJS, Waganaar SS, et al. Primary sarcoma of the lung: a clinical study with long-term follow-up. Ann Thorac Surg. 1994;58:1151-/5.]
  19. Addis BJ, Corrin B: Pulmonary blastoma, carcinosarcoma and spindle-cell carcinoma: An immunohistochemical study of keratin intermediate filaments. J Pathol, 1985; 147(4): 291-301].
  20. Mason RJ, Broaddus VC, Martin T et al: Rare malignant primary pulmonary epithelial tumors. 5th ed. Ch. 48, Part 4. Primary Pulmonary Sarcomas; 2010. Murray and Nadel'sTextbook of Respiratory Medicine.
  21. Vieira T, Girard N, Ung M et al: Efficacy of first-line chemotherapy in patients with advanced lung sarcomatoid carcinoma. J ThoracOncol, 2013; 8: 1574-77.
  22. Italiano A, Cortot AB, Ilie M, et al. EGFR and KRAS status of primary sarcomatoid carcinomas of the lung: Implications for anti-EGFR treatment of a rare lung malignancy. Int J Cancer 2009; 125: 2479-82.
  23. Akao Y, Nakagawa Y, Kitade Y, Kinoshita T, Naoe T. Downregulation of microRNAs-143 and -145 in B-cell malignancies. Cancer Sci 2007; 98: 1914-20