Pulmonary sarcomatoid carcinoma mimicking pleural mesothelioma: A case report

Our plain-English summary of Pulmonary sarcomatoid carcinoma mimicking pleural mesothelioma: A case report, by L. Wang, J. Zhang, X. Chen, et al (Medicine, 2021).

The study

• Authors: L. Wang, J. Zhang, X. Chen, M. Liang, S. Li, W. Zhou, J. Cao
• Journal: Medicine
• Published: 2021;100(45):e27813
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare biphasic tumor characterized by a mixture of malignant epithelial and mesenchymal cells. Owing to the rarity, as well as the lack of typical manifestations and imaging signs, the rate of misdiagnosis is high. Herein, we present a case of PSC misdiagnosed as pleural mesothelioma in a 59-year-old man.

Patient Concerns: A 59-year-old man presented with recurrent coughing, fever, and chest pain.

Diagnosis: Chest computed tomography showed 2 large and dense masses involving the inferior lobes of right lung, along with slight irregular pleural thickening and a small amount of effusion.

Interventions: Chest computed tomography-guided tumor biopsy was performed. PSC was confirmed based on histopathology and immunohistochemistry. The patient refused treatment due to economic reasons.

Outcomes: The patient developed adrenal, multiple lung and brain metastasis. The overall survival time was 11 months.

Conclusions: PSC, despite its rarity, should be considered in the differential diagnosis of lung cancer. Besides, biopsy, histopathology, and specific immunohistochemical staining of larger tissue specimens can be contributing to the accurate diagnosis of PSC.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

This was a case report of one patient from the Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, China. A 59-year-old man was admitted on July 30, 2013 with fever, coughing, shortness of breath and right chest pain. He had smoked for 40 years (25 cigarettes per day). The article does not mention asbestos exposure. A chest CT scan at another hospital showed a large mass in the right lung with pleural thickening and fluid. Tests on pleural fluid and a pleural biopsy pointed to possible mesothelioma. In February 2014 a CT-guided biopsy of the lung mass showed malignant spindle cells. Staining was positive for cytokeratin (CK), CK7 and vimentin, focally positive for P63, and negative for calretinin and D2-40. He was diagnosed with pulmonary sarcomatoid carcinoma (PSC), a rare lung cancer, and declined treatment. He developed adrenal, lung and brain spread and survived 11 months from his first symptoms. The authors concluded that PSC should be considered when diagnosing lung cancer, and that biopsy with specific staining of larger tissue samples can help diagnose it accurately.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient
• Who was studied: One 59-year-old man admitted to the Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, China, on July 30, 2013
• Exposure: No asbestos exposure is reported. The article reports a 40-year history of cigarette smoking at 25 cigarettes per day.
• Main results:
  • Initial pleural biopsy staining (positive for keratin and vimentin, negative for CEA, MC, P53, TTF-1, Ki-67 and calretinin) was interpreted as indicating the possibility of mesothelioma
  • A CT-guided biopsy of the lung mass on February 12, 2014 showed malignant spindle cells (sarcoma-like features)
  • The lung biopsy was positive for cytokeratin (CK), CK7 and vimentin and focally positive for P63. It was negative for EMA, smooth muscle actin, TTF-1, desmin, calretinin and D2-40, and the patient was diagnosed with PSC.
  • The patient declined further treatment, citing the expected poor prognosis and high treatment costs
  • Right adrenal metastasis was found at 1 month of follow-up and multiple lung metastases at 3 months. The patient developed adrenal, multiple lung and brain metastasis.
  • The patient died after seizures; total survival was 11 months from the first symptoms
• The authors' conclusion: The authors concluded that PSC, though rare, should be considered in the differential diagnosis of lung cancer. They emphasized biopsy, histopathology and specific immunohistochemical staining of larger tissue specimens at diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Carcinoma, Pleural Mesothelioma, Biphasic Mesothelioma, Misdiagnosis, Pleural Thickening, Biopsy, Histopathology.

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• MUC4 Staining in Sarcomatoid Carcinomas — K.B. Berg, D. Ionescu, et al. (2019)
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• Pulmonary endpoints (lung carcinomas and asbestosis) following inhalation exposure to asbestos — B.T. Mossman, M. Lippmann, et al. (2011)

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