Lung Cancer |

Pulmonary Sarcomatoid Carcinoma: A Rapidly Metastasizing Rare Cancer Where Close Follow-up and Early Radiation Therapy Is Paramount to Breakthrough in Treatment FREE TO VIEW

Shreya Sinha, MD; Dhruv Lowe, MBBS; Aswini Kumar, MBBS
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SUNY Upstate Medical University, Syracuse, NY

Chest. 2014;146(4_MeetingAbstracts):659A. doi:10.1378/chest.1993801
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SESSION TITLE: Cancer Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcomatoid carcinoma is a group of NSCLC that has histological components of both epithelial and mesothelial origin. It is extremely rare and accounts for less than 1% of all lung cancers. It is typically diagnosed in late stages with widespread metastasis. Due to poor prognosis and tendency of rapid metastasis close follow up with regular imaging and low threshold to initiate RT is required.

CASE PRESENTATION: We present a 44 year old female with a history of COPD, GERD, and 15 pack per year tobacco use who presented for chest trauma in February 2014 and was found to have a large mass in the RUL on CXR. CT scan showed soft tissue mass measuring 7.8x7.5x6.3cm with mediastinal lymphadenopathy. PET and MRI showed no metastatic disease. She underwent a right upper lobectomy. One month later, she complained of severe abdominal pain and an abdominal CT scan was done, which revealed three lesions in the liver, the largest measuring 2.3cmx2.0cm. Systemic chemotherapy was to start in April, but she was admitted in March for worsening mentation and an MRI of the brain revealed a large hemorrhagic mass measuring 5.1cmx3.4cmx4.9cm within the left parietal lobe, two masses in the left temporal lobe (larger measuring 2.2cmx2.3cm), and two additional 1cm ring-enhancing lesions within the left frontal lobe. The hemorrhagic lesion in the parietal lobe worsened during hospitalization and neurosurgical intervention was deemed futile given the extent of disease. She eventually was placed on comfort care measures.

DISCUSSION: Sarcomatoid carcinoma is a very rare, rapidly progressive malignancy. In 2012, a study by Yendamuri of 878,810 patients with lung cancer, found 3,647 (0.4%) to have sarcomatoid cancer and these patients had a significantly worse outcome [1]. A 2011 study by Park found that curative resection led to better outcomes. Our case is unique since after undergoing curative resection, there was wide spread metastasis within a month [2]. This points to the fact that patients require very close follow up and possibly adjuvant chemo-radiation therapy in addition to resection. No study has yet been done to investigate early or adjuvant radiation therapy for these patients.

CONCLUSIONS: In conclusion, sarcomatoid carcinoma is a rare pulmonary malignancy with tendency for rapid metastasis associated with dismal prognosis. Curative resection has shown to improve survival, however, our case emphasizes the need for close monitoring with imaging and possibly adjuvant chemo-radiation therapy. It is thus imperative for the physician to consider initiating treatment with radiation therapy as soon as possible.

Reference #1: Yendamuri S, Caty L, Pine M, Adem S et.al, Outcomes of sarcomatoid carcinoma of the lung: a Surveillance, Epidemiology, and End Results Database analysis; Surgery. 2012;152(3):397

Reference #2: Park JS, Lee Y, Han J et. Al, Clinicopathologic outcomes of curative resection for sarcomatoid carcinoma of the lung. Oncology: 2011;81(3-4):206-13

DISCLOSURE: The following authors have nothing to disclose: Shreya Sinha, Dhruv Lowe, Aswini Kumar

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