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Lung

Sarcomatoid carcinoma

Carcinosarcoma

Author: Roseann I. Wu, M.D., M.P.H.

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

Last author update: 1 May 2017

Last staff update: 6 June 2023

Copyright: 2003-2024, PathologyOutlines.com, Inc.

PubMed Search: Carcinosarcoma [title] lung

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Table of Contents

Cite this page: Wu R. Carcinosarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lungtumorcarcinosarcoma.html. Accessed April 20th, 2024.

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 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:

CT before / after targeted therapy

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

49 year old woman with a SBO secondary to small bowel metastases (Acta Chir Belg 2015;115:49)
50 year old woman with a 45 pack year smoking history (Surg Case Rep 2017;3:52)
50 year old man with complaint of pain in back radiating to right lower limb and chest pain for 3 months (J Cytol 2015r;32:28)
64 year old man with a seven-month history of shortness of breath (Contemp Oncol (Pozn) 2015;19:163)
65 year old man with bronchial carcinosarcoma (J Radiol Case Rep 2012;6:26)
65 year old man with tumor including chest wall invasion (Int J Clin Oncol 2010;15:319)
75 year old woman with diabetes, hypertension, chronic kidney disease, and coronary disease (Ochsner J 2015;15:196)
77 year old man with pulmonary carcinosarcoma and idiopathic pulmonary fibrosis (Lung 2016;194:171)
83 year old woman with glandular and lipoblastic carcinosarcoma (Case Rep Pulmonol 2016;2016:2020146)
Cytology case report (Diagn Cytopathol 1988;4:239)

Treatment

Surgical resection in majority of cases (Surg Today 2014;44:175), followed by radiation
Chemotherapy for cases with metastases
Tumors with EGFR mutation can be considered for targeted therapy (Oncotarget 2017;8:25323)

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

Scroll to see all images

Contributed by Yale Rosen, M.D. and Jian-Hua Qiao, M.D.

Giant cell carcinoma

Core biopsy

AE1 / AE3

CAM 5.2

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

H&E

Virtual slides

Images hosted on other servers:

Rosai collection

Cytology description

May only show epithelial component, i.e. squamous cell carcinoma

Cytology images

Contributed by Jian-Hua Qiao, M.D.

Highly pleomorphic giant cells

Positive stains

Dependent on specific components of tumor

Negative stains

Dependent on specific components of tumor

Molecular / cytogenetics description

TP53 mutations often seen, Kras less frequent, EGFR mutations very uncommon (J Thorac Oncol 2015;10:1243)
Equivalent allelic loss between the two components, supporting monoclonal origin (Am J Surg Pathol 2002;26:510)

Differential diagnosis

Other subtypes of sarcomatoid carcinoma
Sarcomatoid mesothelioma
True sarcomas, such as synovial sarcoma
Other types of sarcomatoid carcinoma such as pulmonary blastoma (younger ages)

Additional references

Review of 6 patients with pulmonary carcinosarcoma (ScientificWorldJournal 2012;2012:167317)

Board review style question #1

The most common epithelial component of a primary pulmonary carcinosarcoma is:

Adenocarcinoma
Adenosquamous carcinoma
Large cell carcinoma
Small cell carcinoma
Squamous cell carcinoma

Board review style answer #1

E. Squamous cell carcinoma

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Reference: Carcinosarcoma

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