Pulmonary carcinosarcoma initially presenting as invasive aspergillosis: a case report of previously unreported combination

Abstract

Carcinosarcoma of the lung is a malignant tumor composed of a mixture of carcinoma and sarcoma elements. The carcinomatous component is most commonly squamous followed by adenocarcinoma. The sarcomatous component commonly comprises the bulk of the tumor and shows poorly differentiated spindle cell features. Foci of differentiated sarcomatous elements such as chondrosarcoma and osteosarcoma may be seen. Aspergillus pneumonia is the most common form of invasive aspergillosis and occurs mainly in patients with malignancy, immunocompromising or debilitating diseases. Patients with Aspergillus pneumonia present with fever, cough, chest pain and occasionally hemoptysis. Tissue examination is the most reliable method for diagnosis, and mortality rate is high.We describe a case of primary carcinosarcoma of the lung concurrently occurring with invasive pulmonary aspergillosis in a 66-year old patient.

Figure 1

A CT scan with contrast of the chest showing large left upper lobe lung mass involving the pleural surface.

Figure 2

A GMS stain showing aspergillus fungal hyphae with uniform septated hyphae, and branching at 45 degrees (×100, Gomori Methanamine Silver stain).

Figure 3

Carcinosarcoma with areas of sarcomatous spindle cell proliferation (left) and an epithelial carcinoma component (right). (×100, Hematoxylin and Eosin).

Figure 4

Epithelial carcinoma component of the tumor positive for cytokeratin AE1/AE3 immunostain (×100).

Figure 5

Epithelial carcinoma component of the tumor showing positivity for epithelial membrane antigen immunostain (EMA) (×100).

Figure 6

Sarcoma component of the tumor showing spindle tumor cells positive for vimentin (×400).

Figure 7

An area of the tumor showing hemorrhagic infarction and shadow outlines of destructed blood vessels (×100, Hematoxylin and Eosin).

Figure 8

Groups of aspergillus fungal hyphae are present in an area of hemorrhagic infarction in the resected specimen (×400, Gomori Methanamine Silver stain).