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
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology description | Cytology images | Positive stains | Negative stains | Molecular / cytogenetics description | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1Cite this page: Wu R. Carcinosarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lungtumorcarcinosarcoma.html. Accessed November 27th, 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.
Images hosted on other servers:
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
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
