Angeliki Cheva, Aggeliki Baliaka, Ioannis Dimitriadis, Styliani Papaemmanouil, Leonidas Sakkas
Background: Sarcomatoid carcinomas of the lung are rare tumors, accounting only for 0.3-1.3% of all lung malignancies and are associated with poor prognosis. They have been classified according to the World Health Organization (WHO) grading system [2004] as pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosarcoma and pulmonary blastoma.
Objective: The presentation of a rare case of sarcomatoid carcinoma/ giant cell carcinoma of lung.
Case presentation: A right pneumonectomy was performed on a 53-year-old male with a large mass, measuring 17 cm in the right lung with grey-tan and creamy cut surface and significant necrosis. Histological evaluation revealed a malignant neoplasm composed of pleomorphic large cells with eosinophilic cytoplasm and large nuclei with prominent nucleoli and high mitotic activity. There were multinucleated and bizarre cells with pleomorphic and often multiplied nuclei. The tumor cells were discohesive or sometimes were aggregated in pseudopapillae. Extensive necrosis and presence of vascular inflammatory granulation tissue were also observed. The immunohistochemical staining results showed: Ck8/18+, Vimentin+, TTF-1-, Ck7-/+, p63-, Ck5/6-, Ck20-, EMA-, SMA- (Ki-67: approximately 30%).
Diagnosis: Sarcomatoid carcinoma/giant cell carcinoma.
Conclusions: Sarcomatoid carcinomas are a heterogeneous group of poorly differentiated non-small cell lung carcinomas that contain a component of sarcoma or sarcoma-like differentiation (WHO 2004). Their diagnosis is particularly difficult because they are uncommon and may overlap morphologically with other anaplastic epithelioid and spindle cell tumors, primary in or metastatic to the lung.
