대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Carcinosarcoma of Lung

Radiologic Findings

Initial chest radiograph (fig a) shows lobulated nodule in the right upper lung. This lesion is rapidly growing on the follow-up chest radiograph 1 month later (fig b). Contrast-enhanced axial CT images (figs c and d) show the lobulated, well-marginated mass in the right upper lobe and the diffuse emphysema in the both lungs. Bone scan image (fig e) shows hot uptake of mass in the right upper lung.

Brief Review

Carcinosarcoma is defined as a biphasic tumor with both carcinomatous and sarcomatous components, with the latter containing elements such as malignant bone, cartilage, or skeletal muscle. The epithelial elements of pulmonary carcinosarcoma are composed of squamous cell carcinoma, adenocarcinoma and undifferentiated large cell carcinoma. This tumor is rare, comprising approximately 0.2-0.3% of all lung malignancies and occurs mainly in the upper lobes. Carcinosarcoma occurs most frequently in males, particularly in smokers in their fifth or sixth decades of life. Broncho-pulmonary carcinosarcoma may appear as a central endobronchial lesion or a peripheral invasive process, the latter tending to be more aggressive. Distant metastasis tends to occur especially from the sarcomatous component of peripheral tumors.

The prognosis is quite poor. The average postoperative survival is nine months and fewer than 10% survived two years. Although surgical resection is the treatment of choice, multi-agent chemotherapy consisting of cyclophosphamide, doxorubicin and cisplatin seem to be a reasonable consideration for use in patients with metastatic carcinosarcoma.

In our case carcinosarcoma is composed of adenocarcinoma of most likely of clear cell type and osteoid forming sarcoma. Carcinoma components have permeated into endolymphatic spaces and metastasized to lymph nodes (fig F).

References

1. Shah R, Sabanathan S. True pulmonary carcinosarcoma. A case report. Undifferentiated carcinoma and chondrosarcoma. J Cardiovasc Surg 2000;41:493-4.

2. Brambilla E, Travis WD, Colby TV, Corrin B, Shimosato Y. The new World Health Organization classification of lung tumours. Eur Respir J 2001;18:1059-68.

3. Koss MN, Hochholzer L, Frommelt RA. Carcinosarcomas of the lung: a clinicopathologic study of 66 patients. Am J Surg Pathol 1999;23:1514-26.

Keywords

Lung, Malignant tumor,