Sarcomatoid carcinoma of the lung other diagnostic studies
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Sarcomatoid Carcinoma of the Lung Microchapters |
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Differentiating Sarcomatoid Carcinoma of the Lung from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]
Overview
The definitive diagnosis of sarcomatoid carcinoma of the lung is made by immunohistochemical staining and pathological subtyping of the specimen collected from biopsy, needle aspiration, sputum cytology or surgical resection of the tumor. Specimen for immunohistochemical analysis and pathological subtyping may be collected by transthoracic needle biopsy, bronchoscopy with biopsy, surgical resection, video-assisted thoracoscopic surgery (VATS), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and rarely sputum cytology.
Other Diagnostic Studies
The definitive diagnosis of sarcomatoid carcinoma of the lung is made by immunohistochemical analysis and pathological subtyping.[1]
- Specimen for immunohistochemical analysis and pathological subtyping may be collected by transthoracic needle biopsy, bronchoscopy with biopsy, surgical resection, video-assisted thoracoscopic surgery (VATS), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and rarely sputum cytology.
Biopsy
- Biopsy findings associated with sarcomatoid carcinoma of the lung will depend on following histopathological subtypes:[2][3]
- Pleomorphic carcinoma
- Poorly differentiated, sarcomatoid carcinoma composed of malignant, spindle and giant cells.
- Spindle cell may vary from epithelioid to strikingly spindled and are arranged in haphazard fascicles or storiform pattern.
- Giant cells are discohesive, uni/multinucleated, have moderate to abundant, dense, eosinophilic cytoplasm which may show emperipolesis by polymorphonuclear leukocytes or lymphocytes.
- Giant cells are anaplastic, with many bizarre forms.
- Tumor cells are embedded in a fibrous or myxoid stroma.
- Spindle cell carcinoma
- Sarcomatoid carcinoma composed only of spindle-shaped tumor cells.
- Giant cell carcinoma
- Sarcomatoid carcinoma composed only of anaplastic, giant tumor cells.
- Carcinosarcoma
- A mixture of carcinoma and true sarcomas such as osteosarcoma, chondrosarcoma or rhabdomyosarcoma.
- 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.
- Pulmonary blastoma
- 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.
- Pleomorphic carcinoma
Immunohistochemical Staining
- Sarcomatoid carcinoma of lung may be positive for the following immunohistochemical markers: [4][5]
- CAM5.2
- CK7
- Thyroid transcription factor 1(TTF-1)
- Napsin A
- AE1/AE3
- WT1
- calretinin
- Sox2
- CK5/6
- p40
- S-100
- desmin
- SMAD2-40
- Desmocollin 3
- Pleomorphic, spindle and/or giant cell carcinoma may show findings positive for component of squamous cell carcinoma, adenocarcinoma, or large cell carcinoma.
- In case of poorly differentiated pleomorphic, spindle and/or giant cell carcinoma markers for epithelial components such as keratin antibodies and EMA (epithelial membrane marker).
- Pleomorphic, spindle and/or giant cell carcinoma may also be positive for cytokeratin, vimentin, carcinoembryonic antigen, and smooth muscle markers.
- Giant cell carcinomas may be positive for TTF-1.
- Carcinosarcomas may be positive for keratin antibodies.
- Variants of carcinosarcoma subtype such as chondrosarcoma may be positive for S-100 protein and rhabdomyosarcoma for muscle markers.
References
- ↑ Roesel, Christian; Terjung, Sarah; Weinreich, Gerhard; Hager, Thomas; Chalvatzoulis, Eleftherios; Metzenmacher, Martin; Welter, Stefan (2016). "Sarcomatoid carcinoma of the lung: a rare histological subtype of non-small cell lung cancer with a poor prognosis even at earlier tumour stages". Interactive CardioVascular and Thoracic Surgery: ivw392. doi:10.1093/icvts/ivw392. ISSN 1569-9293.
- ↑ Sobin LH (1981). "The international histological classification of tumours". Bull. World Health Organ. 59 (6): 813–9. PMC 2396133. PMID 6978190.
- ↑ Hountis P, Moraitis S, Dedeilias P, Ikonomidis P, Douzinas M (June 2009). "Sarcomatoid lung carcinomas: a case series". Cases J. 2: 7900. doi:10.4076/1757-1626-2-7900. PMC 2740247. PMID 19830024.
- ↑ Weissferdt A, Kalhor N, Rodriguez Canales J, Fujimoto J, Wistuba II, Moran CA (January 2017). "Spindle cell and pleomorphic ("sarcomatoid") carcinomas of the lung: an immunohistochemical analysis of 86 cases". Hum. Pathol. 59: 1–9. doi:10.1016/j.humpath.2016.08.003. PMID 27569293.
- ↑ Terra SB, Aubry MC, Yi ES, Boland JM (February 2014). "Immunohistochemical study of 36 cases of pulmonary sarcomatoid carcinoma--sensitivity of TTF-1 is superior to napsin". Hum. Pathol. 45 (2): 294–302. doi:10.1016/j.humpath.2013.09.005. PMID 24331839.