Lung tumor
Other Carcinoma
Carcinosarcoma

Author: Roseann Wu, M.D., M.P.H. (see Authors page)

Editorial Board Member Review: Andrey Bychkov, M.D. Ph.D.

Revised: 8 September 2017, last major update May 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Carcinosarcoma [title] lung
Cite this page: Carcinosarcoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/lungtumorcarcinosarcoma.html. Accessed October 21st, 2017.
Definition / general
  • Subtype of sarcomatoid carcinoma, consisting of a mixture of nonsmall cell lung cancer (typically squamous cell carcinoma or adenocarcinoma) and sarcomatous heterologous elements
  • Monoclonal tumor with divergent lines of differentiation, leading to mixture of carcinomatous and sarcomatous elements (Am J Surg Pathol 2002;26:510)
Essential features
  • Biphasic tumor consisting of a nonsmall cell carcinoma with heterologous sarcomatoid differentiation
  • Rare tumor with poor prognosis
  • Recommend molecular testing according to associated histologic components; i.e. tumors with adenocarcinoma component should be tested for EGFR and ALK (J Thorac Oncol 2015;10:1243)
Terminology
  • Use specific term "carcinosarcoma" rather than general term "sarcomatoid carcinoma" whenever possible to avoid confusion (J Thorac Oncol 2015;10:1243)
  • "Biphasic sarcomatoid carcinoma" has been proposed as replacement term
ICD-10 coding
  • Use code specific for location of tumor
  • C34.90 malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
  • Rare, 0.1% of all lung cancers
  • M > F, most with smoking history, average age 60
Sites
  • Large airways and peripheral lung
Pathophysiology
  • Primary lung carcinoma undergoes sarcomatoid change
Etiology
  • Epithelial malignancy with divergent differentiation
Clinical features
  • Dependent on location: endobronchial lesions have pneumonia, cough, shortness of breath, hemoptysis; peripheral lesions may have no symptoms
Diagnosis
  • Difficult to diagnose on small biopsy / cytology but possible
Radiology images

Images hosted on other servers:

Large mass on CT scan

Mass lesion located left hilar localization

Prognostic factors
  • Poor prognosis overall; increased tumor size appears related to reduced survival (Am J Surg Pathol 1999;23:1514)
  • Better prognosis for smaller or endobronchial lesions
Case reports
Treatment
  • Surgical resection in majority of cases (Surg Today 2014;44:175), followed by radiation
  • Chemotherapy for cases with metastases
Gross description
  • May show central necrosis and hemorrhage if larger tumor
  • Irregular borders, tan to yellow
Gross images

Images hosted on other servers:

Bronchial carcinosarcoma

Microscopic (histologic) description
  • Mixture of carcinomatous and sarcomatous elements
  • Carcinoma component usually squamous but may be glandular or neuroendocrine
  • Heterologous sarcomatoid component, such as rhabdomyosarcoma, osteosarcoma, chondrosarcoma
  • Metastases may show carcinomatous or sarcomatous component or both
Microscopic (histologic) images

Images hosted on other servers:

Various images

Initially presenting
as invasive
aspergillosis


Blastomatoid variant

Lung parenchyma
showing
infiltration

Lipoblastic elements
with spindle cell
component

Adenocarcinoma with acinar growth pattern

Malignant poorly formed epithelial glands


S100

CK7 and TTF1

Carcinoma with atypical glands (mag ×20)

H&E magnification 40× and 400×

Virtual slides
Images hosted on other servers:

Rosai collection

University of Michigan

Cytology description
  • May only show epithelial component, i.e. squamous cell carcinoma
Positive stains
  • Dependent on specific components of tumor
Negative stains
  • Dependent on specific components of tumor
Molecular / cytogenetics description
Differential diagnosis
Additional references
Board review question #1
The most common epithelial component of a primary pulmonary carcinosarcoma is:

  1. Adenocarcinoma
  2. Adenosquamous carcinoma
  3. Large cell carcinoma
  4. Small cell carcinoma
  5. Squamous cell carcinoma
Board review answer #1
E. Squamous cell carcinoma