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| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Sarcomatoid carcinoma of the lung}} |
| {{CMG}} {{AE}} {{Trusha}} {{MV}} | | {{CMG}}; {{AE}} {{Trusha}}, {{MV}} |
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| {{SK}} Primary sarcoma of the lung; Lung sarcoma; Sarcomatoid tumor of the lung | | {{SK}} Primary sarcoma of the lung; Lung sarcoma; Sarcomatoid tumor of the lung; Pulmonary sarcomatoid carcinoma |
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| ==Overview== | | ==[[Sarcomatoid carcinoma of the lung overview|Overview]]== |
| '''Sarcomatoid carcinomas''' are a group of poorly differentiated non-small cell lung carcinomas. Sarcomatoid carcinoma is defined as a biphasic tumor with morphological characteristics of both, carcinomatous and sarcomatous. Sarcomatoid cancer of the lung is a rare type of malignancy and it comprises of only 0.3% to 1.3% of cases of all lung cancers. The pathogenesis of sarcomatoid carcinoma of the lung is characterized by a rare epithelial origin, and morphologic features suggestive of a malignant mesenchymal tumor. The [[EGFR]] gene and [[Ras oncogene|K-ras]] mutations have been associated with the development of sarcomatoid carcinoma of the lung. The prevalence of sarcomatoid carcinoma of the lung is approximately 0.4 cases per 100,000 individuals worldwide. Common risk factors in the development of sarcomatoid carcinoma of the lung are [[smoking]], family history of lung cancer, exposure to high levels of air pollution, asbestos, radiation therapy to the chest, radon gas, occupational exposure to chemical carcinogens, and previous lung diseases. If left untreated, the majority of patients with sarcomatoid carcinoma of the lung may develop distant [[metastasis]] via the lymphogenic route. Common complications of sarcomatoid carcinoma of the lung include respiratory failure, pneumonia, and distant metastasis. Prognosis is generally poor, even worse than other non-small cell carcinoma of the lung. The 5-year survival rate for patients with sarcomatoid cancer of the lung is 28.7%.
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| ==Historical Perspective== | | ==[[Sarcomatoid carcinoma of the lung historical perspective|Historical Perspective]]== |
| *Sarcomatoid carcinoma was first described by Virchow in 1865 as a “biphasic” lesion of adenocarcinomatous or squamous cell components along with spindle or giant cell component.<ref>{{cite book |last=Virchow |first=Rudolf |date=1863 |title=Die KRANKHAFTEN GESCHWÜLSTE |volume=2 |url=https://collections.nlm.nih.gov/catalog/nlm:nlmuid-62231840R-mvset |access-date=1864}}</ref>
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| *In 1981, World Health Organization (WHO) classification on lung cancers, mentioned pleomorphic carcinomas showing a prevalence of spindle or giant cells as morphologic variants of squamous cell carcinomas and large-cell carcinomas, respectively, and defined carcinosarcomas as biphasic tumors consisting of an intimate admixture of carcinoma and sarcoma.<ref name="pmid6978190">{{cite journal |vauthors=Sobin LH |title=The international histological classification of tumours |journal=Bull. World Health Organ. |volume=59 |issue=6 |pages=813–9 |date=1981 |pmid=6978190 |pmc=2396133 |doi= |url=}}</ref>
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| ==Classification== | | ==[[Sarcomatoid carcinoma of the lung classification|Classification]]== |
| Sarcomatoid carcinoma of the lung can be classified according to WHO classification into 5 subtypes:<ref name="pmid6978190">{{cite journal |vauthors=Sobin LH |title=The international histological classification of tumours |journal=Bull. World Health Organ. |volume=59 |issue=6 |pages=813–9 |date=1981 |pmid=6978190 |pmc=2396133 |doi= |url=}}</ref><ref name="BrambillaTravis2001" /> | |
| *Pleomorphic carcinoma
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| *Spindle cell carcinoma
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| *Giant cell carcinoma
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| *Carcinosarcoma
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| *Pulmonary blastoma
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| Sarcomatoid carcinoma of the lung can also be classified according to their location including:<ref name="BrambillaTravis2001" /> | | ==[[Sarcomatoid carcinoma of the lung pathophysiology|Pathophysiology]]== |
| *Central
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| *Peripheral
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| ==Pathophysiology== | | ==[[Sarcomatoid carcinoma of the lung causes|Causes]]== |
| *The pathogenesis of sarcomatoid carcinoma of the lung is characterized by a rare epithelial origin and morphologic features suggestive of a malignant mesenchymal tumor.<ref name="BrambillaTravis2001" /><ref name="pmid20073605">{{cite journal |vauthors=Franks TJ, Galvin JR |title=Sarcomatoid carcinoma of the lung: histologic criteria and common lesions in the differential diagnosis |journal=Arch. Pathol. Lab. Med. |volume=134 |issue=1 |pages=49–54 |year=2010 |pmid=20073605 |doi=10.1043/2008-0547-RAR.1 |url=}}</ref>
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| *The EGFR and K-ras gene mutations have been associated with the development of sarcomatoid carcinoma of the lung.<ref name="BillahStewart2011">{{cite journal|last1=Billah|first1=Shahreen|last2=Stewart|first2=John|last3=Staerkel|first3=Gregg|last4=Chen|first4=Su|last5=Gong|first5=Yun|last6=Guo|first6=Ming|title=EGFR and KRAS mutations in lung carcinoma|journal=Cancer Cytopathology|volume=119|issue=2|year=2011|pages=111–117|issn=1934662X|doi=10.1002/cncy.20151}}</ref>
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| *Four major hypotheses may explain sarcomatoid neoplasms:<ref name="pmid8772780">{{cite journal |vauthors=Thompson L, Chang B, Barsky SH |title=Monoclonal origins of malignant mixed tumors (carcinosarcomas). Evidence for a divergent histogenesis |journal=Am. J. Surg. Pathol. |volume=20 |issue=3 |pages=277–85 |date=March 1996 |pmid=8772780 |doi= |url=}}</ref>
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| **'''The embryonic rest hypothesis:''' This theory suggests that sarcomatoid tumors were the result of misplaced “mini-organs” that is complete with epithelium and stroma.
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| **'''The collision hypothesis:''' This theory implies separate but concomitant proliferation of malignant epithelium and mesenchyme.
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| **'''The stromal induction/metaplasia hypothesis:''' This theory proposes that sarcomatous elements are an atypical response to the growth of a carcinoma rather than neoplastic; and the totipotential hypothesis, which is based on tumor origin from a single stem cell that differentiates into separate epithelial and mesenchymal components.
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| **'''Totipotential hypothesis:''' This hypothesis proposes an origin from a single totipotential stem cell that differentiates into epithelial and mesenchymal components.
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| ===Gross Pathology=== | | ==[[Sarcomatoid carcinoma of the lung differential diagnosis|Differentiating Sarcomatoid carcinoma of the lung from other Diseases]]== |
| * Sarcomatoid carcinomas can arise centrally or peripherally. Most commonly present as poorly circumscribed solitary peripheral masses.<ref name="pmid12604887">{{cite journal |vauthors=Rossi G, Cavazza A, Sturm N, Migaldi M, Facciolongo N, Longo L, Maiorana A, Brambilla E |title=Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements: a clinicopathologic and immunohistochemical study of 75 cases |journal=Am. J. Surg. Pathol. |volume=27 |issue=3 |pages=311–24 |date=March 2003 |pmid=12604887 |doi= |url=}}</ref><ref name="pmid10584705">{{cite journal |vauthors=Koss MN, Hochholzer L, Frommelt RA |title=Carcinosarcomas of the lung: a clinicopathologic study of 66 patients |journal=Am. J. Surg. Pathol. |volume=23 |issue=12 |pages=1514–26 |date=December 1999 |pmid=10584705 |doi= |url=}}</ref>
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| * Sarcomatoid carcinoma is commonly found in upper lobe of lungs.
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| * Tumors are large, ranging from 1 to 13 cm, with a median of 4.9 cm, and often invade the chest wall.
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| * Tumor consistency is described as soft and fleshy or firm, hard, or rubbery.
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| * Cut surfaces vary from white-grey to yellow, frequently show hemorrhagic and necrotic foci, and occasionally demonstrate cavitation.
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| ===Microscopic Pathology=== | | ==[[Sarcomatoid carcinoma of the lung epidemiology and demographics|Epidemiology and Demographics]]== |
| *On microscopic histopathologically sarcomatoid carcinoma is classified into 5 subtypes:<ref name="pmid19830024">{{cite journal |vauthors=Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M |title=Sarcomatoid lung carcinomas: a case series |journal=Cases J |volume=2 |issue= |pages=7900 |date=June 2009 |pmid=19830024 |pmc=2740247 |doi=10.4076/1757-1626-2-7900 |url=}}</ref>
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| **'''Pleomorphic carcinoma'''
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| ***Poorly differentiated, sarcomatoid carcinoma composed of malignant, spindle and giant cells.
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| ***Spindle cell may vary from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern.
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| ***Giant cells are discohesive, uni/multinucleated, have moderate to abundant, dense, eosinophilic cytoplasm which may show emperipolesis by polymorphonuclear leukocytes or lymphocytes.
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| ***Giant cells are anaplastic, with many bizarre forms.
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| ***Tumor cells are embedded in a fibrous or myxoid stroma.
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| ** '''Spindle cell carcinoma'''
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| *** Sarcomatoid carcinoma composed only of spindle-shaped tumor cells.
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| ** '''Giant cell carcinoma'''
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| *** Sarcomatoid carcinoma composed only of anaplastic, giant tumor cells.
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| ** '''Carcinosarcoma'''
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| *** A mixture of carcinoma and true sarcomas such as malignant bone sarcoma, cartilage, or skeletal muscle sarcoma.
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| *** The carcinoma component may be squamous cell carcinoma, adenocarcinoma, adenocarcinoma mixed with squamous cell carcinoma, and large cell carcinoma, whereas the sarcoma component may be rhabdomyosarcoma, osteosarcoma mixed with chondrosarcoma, and osteosarcoma.
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| ** '''Pulmonary blastoma'''
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| *** A biphasic tumor composed of a primitive epithelial component with well-differentiated, fetal adenocarcinoma and a primitive mesenchymal stroma that may contain rhabdomyosarcoma, osteosarcoma, or chondrosarcoma.
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| ==Causes== | | ==[[Sarcomatoid carcinoma of the lung risk factors|Risk Factors]]== |
| There are no direct causes of sarcomatoid carcinoma of lung. However, there are a few risk factors that can lead to genetic mutation and cause sarcomatoid carcinoma of lung.
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| ==Differentiating sarcomatoid carcinoma of the lung from other Diseases==
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| Sarcomatoid carcinoma of the lung must be differentiated from other diseases that cause cough, weight loss, hemoptysis, and dyspnea among adults, such as:
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| *[[Tuberculosis]]
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| *[[Adenocarcinoma of the lung]]
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| *Small cell carcinoma of the lung
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| *Pulmonary fungal disease
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| *[[Lung abscess]]
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| ==Epidemiology and Demographics== | | ==[[Sarcomatoid carcinoma of the lung screening|Screening]]== |
| ===Prevalence===
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| * The prevalence of sarcomatoid carcinoma of the lung is approximately 0.4 cases per 100,000 individuals worldwide.<ref name="pmid20073605">{{cite journal |vauthors=Franks TJ, Galvin JR |title=Sarcomatoid carcinoma of the lung: histologic criteria and common lesions in the differential diagnosis |journal=Arch. Pathol. Lab. Med. |volume=134 |issue=1 |pages=49–54 |year=2010 |pmid=20073605 |doi=10.1043/2008-0547-RAR.1 |url=}}</ref>
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| *Sarcomatoid carcinoma comprises of 0.3% to 1.3% of total lung malignancies.<ref>{{cite book |last1=Travis WD |last2=Brambilla E |last3=Müller-Hermelink K |last4=Harris C |last5=Kleihues C |last6=Sobin P |title=World Health Organization Classification of Tumours; Pathology and genetics of tumors of the lung, pleura, thymus, and heart |publisher=IARC Press |orig-year=2004 |pages=53-58|chapterurl=https://www.iarc.fr/wp-content/uploads/2018/07/BB10.pdf |isbn=ISBN 92 832 2418 3}}</ref>
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| *The overall prevalence of sarcomatoid carcinoma of the lung is 0.1% to 0.4% of all non-small cell lung malignancies.<ref name="BrambillaTravis2001">{{cite journal|last1=Brambilla|first1=E.|last2=Travis|first2=W.D.|last3=Colby|first3=T.V.|last4=Corrin|first4=B.|last5=Shimosato|first5=Y.|title=The new World Health Organization classification of lung tumours|journal=European Respiratory Journal|volume=18|issue=6|year=2001|pages=1059–1068|issn=0903-1936|doi=10.1183/09031936.01.00275301}}</ref>
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| ===Age=== | | ==[[Sarcomatoid carcinoma of the lung natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Sarcomatoid carcinoma of the lung is more commonly diagnosed among patients aged 65 to 75 years old.<ref name="OuzianeBoutayeb2014">{{cite journal|last1=Ouziane|first1=Imane|last2=Boutayeb|first2=Saber|last3=Mrabti|first3=Hind|last4=Lalya|first4=Issam|last5=Rimani|first5=Mouna|last6=Errihani|first6=Hassan|title=Sarcomatoid carcinoma of the lung: A model of resistance of chemotherapy|journal=North American Journal of Medical Sciences|volume=6|issue=7|year=2014|pages=342|issn=1947-2714|doi=10.4103/1947-2714.136920}}</ref>
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| * Sarcomatoid carcinoma of the lung is more commonly observed among elderly patients and adults.
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| * Biphasic blastoma subtype is an exception and an average age of 35 years old patients being more commonly diagnosed
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| ===Gender=== | | ==Diagnosis== |
| *Males are more commonly affected with sarcomatoid carcinoma of the lung than females.<ref name="PetrovVlassov2003">{{cite journal|last1=Petrov|first1=D.B|last2=Vlassov|first2=V.I|last3=Kalaydjiev|first3=G.T|last4=Plochev|first4=M.A|last5=Obretenov|first5=E.D|last6=Stanoev|first6=V.I|last7=Danon|first7=S.E|title=Primary pulmonary sarcomas and carcinosarcomas – postoperative results and comparative survival analysis|journal=European Journal of Cardio-Thoracic Surgery|volume=23|issue=4|year=2003|pages=461–466|issn=10107940|doi=10.1016/S1010-7940(03)00024-1}}</ref><ref name="RoeselTerjung2016">{{cite journal|last1=Roesel|first1=Christian|last2=Terjung|first2=Sarah|last3=Weinreich|first3=Gerhard|last4=Hager|first4=Thomas|last5=Chalvatzoulis|first5=Eleftherios|last6=Metzenmacher|first6=Martin|last7=Welter|first7=Stefan|title=Sarcomatoid carcinoma of the lung: a rare histological subtype of non-small cell lung cancer with a poor prognosis even at earlier tumour stages|journal=Interactive CardioVascular and Thoracic Surgery|year=2016|pages=ivw392|issn=1569-9293|doi=10.1093/icvts/ivw392}}</ref>
| | [[Sarcomatoid carcinoma of the lung diagnostic study of choice|Diagnostic study of choice]] | [[Sarcomatoid carcinoma of the lung history and symptoms|History and Symptoms]] | [[Sarcomatoid carcinoma of the lung physical examination|Physical Examination]] | [[Sarcomatoid carcinoma of the lung laboratory findings|Laboratory Findings]] | [[Sarcomatoid carcinoma of the lung electrocardiogram|Electrocardiogram]] | [[Sarcomatoid carcinoma of the lung x ray|X-Ray Findings]] | [[Sarcomatoid carcinoma of the lung echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Sarcomatoid carcinoma of the lung CT scan|CT-Scan Findings]] | [[Sarcomatoid carcinoma of the lung MRI|MRI Findings]] | [[Sarcomatoid carcinoma of the lung other imaging findings|Other Imaging Findings]] | [[Sarcomatoid carcinoma of the lung other diagnostic studies|Other Diagnostic Studies]] |
| *the male to female ratio is 4:1.<ref name="OuzianeBoutayeb2014">{{cite journal|last1=Ouziane|first1=Imane|last2=Boutayeb|first2=Saber|last3=Mrabti|first3=Hind|last4=Lalya|first4=Issam|last5=Rimani|first5=Mouna|last6=Errihani|first6=Hassan|title=Sarcomatoid carcinoma of the lung: A model of resistance of chemotherapy|journal=North American Journal of Medical Sciences|volume=6|issue=7|year=2014|pages=342|issn=1947-2714|doi=10.4103/1947-2714.136920}}</ref>
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| *Biphasic blastoma subtype is an exception, that affects men and women equally.
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| ===Race=== | | ==Treatment== |
| *There is no racial predilection for sarcomatoid carcinoma of the lung.
| | [[Sarcomatoid carcinoma of the lung medical therapy|Medical Therapy]] | [[Sarcomatoid carcinoma of the lung surgery|Surgery]] | [[Sarcomatoid carcinoma of the lung primary prevention|Primary Prevention]] | [[Sarcomatoid carcinoma of the lung secondary prevention|Secondary Prevention]] | [[Sarcomatoid carcinoma of the lung cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Sarcomatoid carcinoma of the lung future or investigational therapies|Future or Investigational Therapies]] |
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| ===Region=== | | ==Case Studies== |
| Geographical location has no effect on epidemiology of sarcomatoid carcinoma of the lung.
| | [[Sarcomatoid carcinoma of the lung medical case study one|Case #1]] |
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| ==Risk Factors==
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| Common risk factors in the development of sarcomatoid carcinoma of the lung are the following:<ref name="pmid15173269">{{cite journal |vauthors=Henley SJ, Thun MJ, Chao A, Calle EE |title=Association between exclusive pipe smoking and mortality from cancer and other diseases |journal=J. Natl. Cancer Inst. |volume=96 |issue=11 |pages=853–61 |date=June 2004 |pmid=15173269 |doi= |url=}}</ref><ref name="pmid9365295">{{cite journal |vauthors=Hackshaw AK, Law MR, Wald NJ |title=The accumulated evidence on lung cancer and environmental tobacco smoke |journal=BMJ |volume=315 |issue=7114 |pages=980–8 |date=October 1997 |pmid=9365295 |pmc=2127653 |doi= |url=}}</ref><ref name="pmid16155281">{{cite journal |vauthors=Freudenheim JL, Ritz J, Smith-Warner SA, Albanes D, Bandera EV, van den Brandt PA, Colditz G, Feskanich D, Goldbohm RA, Harnack L, Miller AB, Rimm E, Rohan TE, Sellers TA, Virtamo J, Willett WC, Hunter DJ |title=Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies |journal=Am. J. Clin. Nutr. |volume=82 |issue=3 |pages=657–67 |date=September 2005 |pmid=16155281 |doi=10.1093/ajcn.82.3.657 |url=}}</ref><ref name="pmid15322513">{{cite journal |vauthors=Boffetta P |title=Epidemiology of environmental and occupational cancer |journal=Oncogene |volume=23 |issue=38 |pages=6392–403 |date=August 2004 |pmid=15322513 |doi=10.1038/sj.onc.1207715 |url=}}</ref>
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| *History of cigarettes, cigars, or pipe smoking
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| *Secondhand or passive smoking
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| *Family history of lung cancer
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| *Genetic predisposition
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| *High levels of air pollution
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| *Radiation therapy to the chest
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| *Heavy alcohol consumption
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| *Radon gas
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| *Occupational exposure to silica, asbestos, uranium, arsenic, chromium, or nuclear radiation
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| *Previous history of lung diseases
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| == Natural History, Complications and Prognosis==
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| *The majority of patients with sarcomatoid carcinoma of the lung remain are initially asymptomatic.
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| *Early clinical features include chronic [[cough]], [[hemoptysis]], [[dyspnea]], weight loss and [[fatigue]].<ref>{{cite book |last1=Travis WD |last2=Brambilla E |last3=Müller-Hermelink K |last4=Harris C |last5=Kleihues C |last6=Sobin P |title=World Health Organization Classification of Tumours; Pathology and genetics of tumors of the lung, pleura, thymus, and heart |publisher=IARC Press |orig-year=2004 |pages=53-58|chapterurl=https://www.iarc.fr/wp-content/uploads/2018/07/BB10.pdf |isbn=ISBN 92 832 2418 3}}</ref>
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| *The majority of patients with central sarcomatoid carcinoma of the lung may develop distant metastasis to esophagus, jejunum, rectum and kidney.
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| *Sarcomatoid carcinoma of lung located in the periphery of lungs tends be diagnosed later in the advanced stages with the large size and metastasis to the pleura and chest wall.
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| *Common complications of sarcomatoid carcinoma of the lung include [[respiratory failure]], [[pneumonia]], and distant metastasis.
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| *If left untreated Sarcomatoid carcinoma progresses to death.
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| *Prognosis is generally poor.<ref name="pmid22739072">{{cite journal |vauthors=Yendamuri S, Caty L, Pine M, Adem S, Bogner P, Miller A, Demmy TL, Groman A, Reid M |title=Outcomes of sarcomatoid carcinoma of the lung: a Surveillance, Epidemiology, and End Results Database analysis |journal=Surgery |volume=152 |issue=3 |pages=397–402 |year=2012 |pmid=22739072 |doi=10.1016/j.surg.2012.05.007 |url=}}</ref><ref name="pmid19830024">{{cite journal |vauthors=Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M |title=Sarcomatoid lung carcinomas: a case series |journal=Cases J |volume=2 |issue= |pages=7900 |year=2009 |pmid=19830024 |pmc=2740247 |doi=10.4076/1757-1626-2-7900 |url=}}</ref>
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| *According to a study, the 3-year and 5-year survival rates for patients with sarcomatoid cancer of lung are 35.8 and 28.7%.<ref name="RoeselTerjung2016">{{cite journal|last1=Roesel|first1=Christian|last2=Terjung|first2=Sarah|last3=Weinreich|first3=Gerhard|last4=Hager|first4=Thomas|last5=Chalvatzoulis|first5=Eleftherios|last6=Metzenmacher|first6=Martin|last7=Welter|first7=Stefan|title=Sarcomatoid carcinoma of the lung: a rare histological subtype of non-small cell lung cancer with a poor prognosis even at earlier tumour stages|journal=Interactive CardioVascular and Thoracic Surgery|year=2016|pages=ivw392|issn=1569-9293|doi=10.1093/icvts/ivw392}}</ref>
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| == Diagnosis ==
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| ===Diagnostic Study of Choice===
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| * Diagnostic modality of choice for sarcomatoid carcinoma of lung is CT scan of the chest.<ref name="PurandareRangarajan20152">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>
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| * The definitive diagnosis of sarcomatoid carcinoma of the lung is made by immunohistochemical analysis and pathological subtyping of the specimen collected from biopsy, needle aspiration, sputum cytology or surgical resection of the tumor.<ref name="RoeselTerjung2016" /><ref name="RoeselTerjung20162">{{cite journal|last1=Roesel|first1=Christian|last2=Terjung|first2=Sarah|last3=Weinreich|first3=Gerhard|last4=Hager|first4=Thomas|last5=Chalvatzoulis|first5=Eleftherios|last6=Metzenmacher|first6=Martin|last7=Welter|first7=Stefan|title=Sarcomatoid carcinoma of the lung: a rare histological subtype of non-small cell lung cancer with a poor prognosis even at earlier tumour stages|journal=Interactive CardioVascular and Thoracic Surgery|year=2016|pages=ivw392|issn=1569-9293|doi=10.1093/icvts/ivw392}}</ref>
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| === History and Symptoms ===
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| Common symptoms of sarcomatoid carcinoma of the lung include:<ref name="pmid19830024">{{cite journal |vauthors=Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M |title=Sarcomatoid lung carcinomas: a case series |journal=Cases J |volume=2 |issue= |pages=7900 |year=2009 |pmid=19830024 |pmc=2740247 |doi=10.4076/1757-1626-2-7900 |url=}}</ref><ref name="RoeselTerjung20162" />
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| *[[Shortness of breath]]
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| *[[Cough]]
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| *[[Hemoptysis]]
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| *[[Chest pain]]
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| *Weight loss
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| *[[Fatigue]]
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| *Other symptoms may be secondary to metastases to bone, contralateral lung, brain, adrenal glands, and liver.
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| === Physical Examination ===
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| Physical exam findings for sarcomatoid carcinoma of lung is similar to physical exam finding of other [[Lung cancer physical examination|lung cancer]].
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| * Please [[Lung cancer physical examination|click here]] for physical exam finding of lung cancer.
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| === Laboratory Findings ===
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| *There are no specific laboratory findings associated with sarcomatoid carcinoma of the lung.
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| === X-ray ===
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| An x-ray may be helpful in the diagnosis of lung cancer. Findings on an x-ray suggestive of lung cancer include:<ref name="JackmanJohnson2005">{{cite journal|last1=Jackman|first1=David M|last2=Johnson|first2=Bruce E|title=Small-cell lung cancer|journal=The Lancet|volume=366|issue=9494|year=2005|pages=1385–1396|issn=01406736|doi=10.1016/S0140-6736(05)67569-1}}</ref><ref name="WhittenKhan2007">{{cite journal|last1=Whitten|first1=Camilla R.|last2=Khan|first2=Sameer|last3=Munneke|first3=Graham J.|last4=Grubnic|first4=Sisa|title=A Diagnostic Approach to Mediastinal Abnormalities|journal=RadioGraphics|volume=27|issue=3|year=2007|pages=657–671|issn=0271-5333|doi=10.1148/rg.273065136}}</ref><ref name="PurandareRangarajan2015">{{cite journal|last1=Purandare|first1=NilenduC|last2=Rangarajan|first2=Venkatesh|title=Imaging of lung cancer: Implications on staging and management|journal=Indian Journal of Radiology and Imaging|volume=25|issue=2|year=2015|pages=109|issn=0971-3026|doi=10.4103/0971-3026.155831}}</ref>
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| * An obvious mass
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| * Widening of the [[mediastinum]]
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| * [[Atelectasis]]
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| * Consolidations
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| * [[Pleural effusion]]
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| * [[Mediastinum|Mediastinal]] [[lymphadenopathy]]
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| * Lung [[Nodule (medicine)|nodules]]
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| === CT scan/PET-CT ===
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| *CT scan of chest is the imaging investigation of choice for sarcomatoid carcinoma of the lung.<ref name="PurandareRangarajan20152" />
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| *CT scan is useful in diagnosing the tumor and also to rule out any possible metastasis.
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| *On CT, sarcomatoid carcinoma of the lung is characterized by the following findings:
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| **Sarcomatoid carcinoma of the lung may arise from center or the peripheral part of the lung
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| **Usually measure approximately 5 cm in diameter
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| **Mixed density
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| **Perihilar and mediastinal involvement
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| **Ground glass opacity
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| **Rapid growth
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| === Other Diagnostic Studies ===
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| *The definitive diagnosis of sarcomatoid carcinoma of the lung is made by immunohistochemical analysis and pathological subtyping of the specimen collected from biopsy, needle aspiration, sputum cytology or surgical resection of the tumor.<ref name="RoeselTerjung2016" /><ref name="RoeselTerjung20162" />
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| *Biopsy findings associated with sarcomatoid carcinoma of the lung will depend on the histopathological subtypes, which include:<ref name="pmid6978190" /><ref name="pmid19830024" />
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| **'''Pleomorphic carcinoma'''
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| ***Poorly differentiated, sarcomatoid carcinoma composed of malignant, spindle and giant cells.
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| ***Spindle cell may vary from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern.
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| ***Giant cells are discohesive, uni/multinucleated, have moderate to abundant, dense, eosinophilic cytoplasm which may show emperipolesis by polymorphonuclear leukocytes or lymphocytes.
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| ***Giant cells are anaplastic, with many bizarre forms.
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| ***Tumor cells are embedded in a fibrous or myxoid stroma.
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| ** '''Spindle cell carcinoma'''
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| *** Sarcomatoid carcinoma composed only of spindle-shaped tumor cells.
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| ** '''Giant cell carcinoma'''
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| *** Sarcomatoid carcinoma composed only of anaplastic, giant tumor cells.
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| ** '''Carcinosarcoma'''
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| *** A mixture of carcinoma and true sarcomas such as malignant bone sarcoma, cartilage, or skeletal muscle sarcoma.
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| *** The carcinoma component may be squamous cell carcinoma, adenocarcinoma, adenocarcinoma mixed with squamous cell carcinoma, and large cell carcinoma, whereas the sarcoma component may be rhabdomyosarcoma, osteosarcoma mixed with chondrosarcoma, and osteosarcoma.
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| ** '''Pulmonary blastoma'''
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| *** A biphasic tumor composed of a primitive epithelial component with well-differentiated, fetal adenocarcinoma and a primitive mesenchymal stroma that may contain rhabdomyosarcoma, osteosarcoma, or chondrosarcoma.
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| * Sarcomatoid carcinoma of lung may be positive for the following immunohistochemical markers: <ref name="pmid27569293">{{cite journal |vauthors=Weissferdt A, Kalhor N, Rodriguez Canales J, Fujimoto J, Wistuba II, Moran CA |title=Spindle cell and pleomorphic ("sarcomatoid") carcinomas of the lung: an immunohistochemical analysis of 86 cases |journal=Hum. Pathol. |volume=59 |issue= |pages=1–9 |date=January 2017 |pmid=27569293 |doi=10.1016/j.humpath.2016.08.003 |url=}}</ref><ref name="pmid24331839">{{cite journal |vauthors=Terra SB, Aubry MC, Yi ES, Boland JM |title=Immunohistochemical study of 36 cases of pulmonary sarcomatoid carcinoma--sensitivity of TTF-1 is superior to napsin |journal=Hum. Pathol. |volume=45 |issue=2 |pages=294–302 |date=February 2014 |pmid=24331839 |doi=10.1016/j.humpath.2013.09.005 |url=}}</ref>
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| ** CAM5.2, CK7, thyroid transcription factor 1(TTF-1), napsin A, AE1/AE3, WT1, calretinin, Sox2, CK5/6, p40, S-100, desmin, SMAD2-40 and/or desmocollin 3.
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| *Sarcomatoid carcinoma of the lung may also be diagnosed using [[bronchoscopy]], [[mediastinoscopy]], and transthoracic percutaneous fine needle aspiration.
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| == Treatment ==
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| === Medical Therapy ===
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| *The mainstay of therapy of sarcomatoid carcinoma of the lung is supportive care.
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| *Common medical treatment for sarcomatoid carcinoma of the lung is the platinum-based chemotherapy.<ref name="pmid19830024">{{cite journal |vauthors=Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M |title=Sarcomatoid lung carcinomas: a case series |journal=Cases J |volume=2 |issue= |pages=7900 |year=2009 |pmid=19830024 |pmc=2740247 |doi=10.4076/1757-1626-2-7900 |url=}}</ref>
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| *If cancer advances during or after platinum-based chemotherapy, treatment with [[nivolumab]] and [[docetaxel]] has shown better survival rate. Longer survival rate especially with nivolumab.<ref name="BorghaeiPaz-Ares2015">{{cite journal|last1=Borghaei|first1=Hossein|last2=Paz-Ares|first2=Luis|last3=Horn|first3=Leora|last4=Spigel|first4=David R.|last5=Steins|first5=Martin|last6=Ready|first6=Neal E.|last7=Chow|first7=Laura Q.|last8=Vokes|first8=Everett E.|last9=Felip|first9=Enriqueta|last10=Holgado|first10=Esther|last11=Barlesi|first11=Fabrice|last12=Kohlhäufl|first12=Martin|last13=Arrieta|first13=Oscar|last14=Burgio|first14=Marco Angelo|last15=Fayette|first15=Jérôme|last16=Lena|first16=Hervé|last17=Poddubskaya|first17=Elena|last18=Gerber|first18=David E.|last19=Gettinger|first19=Scott N.|last20=Rudin|first20=Charles M.|last21=Rizvi|first21=Naiyer|last22=Crinò|first22=Lucio|last23=Blumenschein|first23=George R.|last24=Antonia|first24=Scott J.|last25=Dorange|first25=Cécile|last26=Harbison|first26=Christopher T.|last27=Graf Finckenstein|first27=Friedrich|last28=Brahmer|first28=Julie R.|title=Nivolumab versus Docetaxel in Advanced Nonsquamous Non–Small-Cell Lung Cancer|journal=New England Journal of Medicine|volume=373|issue=17|year=2015|pages=1627–1639|issn=0028-4793|doi=10.1056/NEJMoa1507643}}</ref>
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| === Surgery===
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| *Surgery is the mainstay of therapy for sarcomatoid carcinoma of the lung.
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| *Lobectomy along with regional lymph nodes (peribronchial and perihilar lymph node dissection) in conjunction with pathological evaluation is the most common approach to the treatment of sarcomatoid carcinoma of the lung.
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| === Prevention ===
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| *Effective measures for the primary prevention of sarcomatoid carcinoma of the lung include CT screening.
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| *For information regarding current [[lung cancer screening]] guidelines [[Lung cancer screening|click here]].
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| ==References==
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| {{Reflist|2}}
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| | | |
| [[Category: Oncology]] | | [[Category: Oncology]] |