A Rare Case of Sarcomatoid Carcinoma of the Lung with Spine Metastasis, Including a Literature Review

Abstract

BACKGROUND Sarcomatoid carcinoma is a rare, aggressive, malignant cancer composed of sarcoma and sarcoma-like components, and can occur in different organs such as the thyroid gland, bone, skin, breast, pancreas, liver, urinary tract, and lung. Pulmonary sarcomatoid carcinoma accounts for only a small percentage of lung cancers and has histological variants that include pleomorphic carcinoma, giant cell carcinoma, spindle cell carcinoma, carcinosarcoma, and pulmonary blastoma. CASE REPORT Here, we present a case of sarcomatoid carcinoma in a 63-year-old HIV-positive Hispanic male who presented with back pain, dry cough, and weight loss. A CT scan of his chest showed an ovoid mass in the lower lobe of the left lung, and an MRI of the spine showed a left lateral paraspinal soft tissue mass causing central canal stenosis and mild cord compression. The patient underwent laminectomy and resection of the spinal mass. A transthoracic needle biopsy of the lung and spinal masses had similar histopathology, and were indicative of sarcomatoid carcinoma. CONCLUSIONS We report a rare case of sarcomatoid carcinoma involving both the lung and spinal cord in the same patient. Sarcomatoid carcinomas of the lung have poor prognosis and are aggressive cancers. Moreover, our case also had the co-occurrence of HIV and sarcomatoid carcinoma.

Figure 1.

Chest radiographs of the patient. (A) PA view and (B) lateral view of the patient’s chest showing a retro-cardiac ovoid mass (arrows) in the lower left lobe.

Figure 2.

CT scans of the chest. The (A) axial, (B) sagittal, and (C) coronal views showing an ovoid mass (arrows) in the lower left lobe measuring 7.4×6.3 cm in the axial plane by approximately 6 cm from superior to inferior.

Figure 3.

MRI images of the thoracic spine. Images in (A) and (B) show an osseous soft tissue lesion (arrows). The lesion involved the posterior elements of the T8 vertebral body, extending into the posterior epidural space, and resulted in severe central canal stenosis and mild cord compression at this level.

Figure 4.

PET scans. (A) Abnormal hypermetabolic activity was identified in a mass (arrow) in the lower lobe of the left lung. (B) A paraspinal soft tissue mass (arrow) with abnormal hypermetabolic activity was identified.

Figure 5.

Results of immunohistochemical staining. (A) The tumor cells consisted of malignant spindle cells (sarcoma-like features) within abundant fibrous stroma (HE stain; magnification ×200). (B) The malignant spindle cells showed nuclear polymorphism and mitotic figures (HE stain; high magnification ×400). (C) The tumor cells were strongly immunoreactive to cytokeratin (CAM 5.2) stain.