SESSION TITLE: Cancer Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Monday, October 27, 2014 at 11:00 AM - 12:00 PM
INTRODUCTION: Sarcomatoid carcinoma is a very rare Non-Small cell lung carcinoma (NSCLC) which usually presents as a lung mass. We present an extremely rare case of sarcomatoid carcinoma presenting as a soft tissue mass in a large bullae disguising as an aspergilloma.
CASE PRESENTATION: A 44 year old male with 20 pack year smoking history, hypertension presented to our hospital with 3 days of shortness of breath, cough with intermittent hemoptysis. Patient also complained of night sweats and 15 pound weight loss over a month. Chest X ray and CT chest revealed multiple right upper lobe (RUL) bullae and emphysema. Largest bullae measured 8.7 x 8.8 x 7.6 cm with a 4.9 x 2.5 x 1.4 cm soft tissue mass, likely “aspergilloma” (Image 1 A, 1B). Patient was also recently told in another hospital that he has a “fungal ball” in his lung. Due to hemoptysis, it was decided to surgically resect the mass. He underwent a wedge resection of right upper lobe bullae with mass. Histology showed malignant sarcomatoid carcinoma (Image 1 C) with no lymphovascular invasion. Resected parenchymal margins were free of cancer. Repeat PET-CT a month later was negative for any malignancy. Patient did well clinically and needed no additional treatment.
DISCUSSION: Sarcomatoid carcinoma of lung is a very rare tumor accounting for < 1 % of all lung cancers. It is poorly differentiated NSCLCs containing a component with sarcoma or sarcoma-like (spindle and/or giant cell) features1. It usually presents as a lung mass. To our knowledge, this is the first case of sarcomatoid carcinoma presenting as mass within a large bullae. On reviewing this case, it can be noticed that there was a pedicle which attached the soft tissue mass to the wall of the bullae (Image 1 A). A common differential for a soft tissue mass in cavity/bullae is aspergilloma. Aspergilloma is a mobile “fungus ball” within the cavity and does not have a stalk. Thus a soft tissue density in a cavity or bullae with a pedicle should raise a suspicion for tumor and needs further work up.
CONCLUSIONS: A soft tissue mass in a bullae presenting with hemoptysis is not always aspergilloma. Tumor should be considered in differential diagnosis for such lesions. Special attention should be paid to the CT imaging of such lesions to see if there is a pedicle attaching the mass to the wall of the bullae.
Reference #1: Pelosi G et al. International Journal of Surgical Pathology 2010 Apr; 18(2):103-20
DISCLOSURE: The following authors have nothing to disclose: Nidhi Aggarwal, Vishesh Paul, Kabu Chawla, William Pascal
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