Lung Cancer: Lung Cancer |

An Unusual Cause of Lung Malignancy FREE TO VIEW

Qiumei Wu, MMed; Lee Lan Phoa, MMed
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Khoo Teck Puat Hospital, Singapore, Singapore

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A260. doi:10.1016/j.chest.2016.02.272
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Sarcomatoid lung carcinoma is a rare non small cell lung cancer (NSCLC) that is estimated to make up 0.2-0.3% of lung malignancy. We report a case of sarcomatoid lung cancer with complete resection with clear margins.

CASE PRESENTATION: A 28-year old gentleman, with no past medical history of note, presented to our institution with a 3-day history of fever, shortness of breath, cough and sore throat. He is a social smoker for 2 years. Physical examination was unremarkable except for decrease air entry on the left. CT scan showed total collapse of the right lung with an abrupt cut-off is seen in the right main bronchus (RMB), 1cm from the carina where a round filling defect is seen (Fig. 1). Flexible bronchoscopy revealed a endobronchial tumour with complete obstruction of the RMB. He underwent rigid bronchoscopy and resection of the proximal part of tumor using electrosurgical snare and YAG laser, however, the procedurist was unable to reopen right middle and lower lobe because of vascularity of the tumor. He subsequently underwent right thoracotomy with resection of right lower lobe and pedunculated mass (4.5cm) that originated from the right lower lobe and extending to the RMB (Fig 3). Histopathological findings of right lung mass revealed to be of spindle cell origin, staining positively for AE1/3.

DISCUSSION: Sarcomatoid lung carcinoma (SCC) is rare group of poorly differentiated NSCLC with sarcoma or spindle and/or giant cell differentiation, based on the WHO classification1. It is more common in male than female patients (4 to 5:1), in smokers and in patients in their 5th and 8th decades1. It has a more aggressive nature compared to other NSCLCs2. Surgical resection of the tumor is the treatment of choice followed by radiotherapy if clear margins cannot be obtained2. Studies involving monoclonal antibodies targeting epidermal growth factor receptor mutations have yet to show any definitive outcomes. Local recurrence is common. The average survival for SCC ranges between 11 - 13.3 months3. Prognosis of the patients was influenced by age, tumor size, T stage, metastatic status, surgical resection and chemotherapy, of which tumor size and metastatic status were independent prognostic factors3.

CONCLUSIONS: The final diagnosis for this patient is Stage IIb sarcomatoid lung cancer (T3N0M0). He subsequently had 4 cycles of adjuvant chemotherapy and follow up showed no evidence of recurrence after 1 year.

Reference #1: Travis WD et al (2004) World health organisation classification of tumours. Pathology and genetics of the lung, pleura, thymus and heart. IARC Press, Lyon, pp 512-536

Reference #2: Si-Yuan Huang et al. Pulmonary sarcomatoid carcinoma: a clinicopathologic study and prognostic analysis of 51 cases World Journal of Surgical Oncology 2013, 11:252 doi:10.1186/1477-7819-11-252

Reference #3: Italiano A 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, 125:2479-2482.

DISCLOSURE: The following authors have nothing to disclose: Qiumei Wu, Lee Lan Phoa

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