Lung
Sarcomatoid carcinoma
Carcinosarcoma

Editorial Board Member: Andrey Bychkov, M.D., Ph.D.
Roseann Wu, M.D., M.P.H.

Topic Completed: 1 May 2017

Minor changes: 29 September 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: Carcinosarcoma [title] lung

Roseann Wu, M.D., M.P.H.
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Cite this page: Wu R. Carcinosarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumorcarcinosarcoma.html. Accessed October 24th, 2020.
Definition / general
  • Subtype of sarcomatoid carcinoma, consisting of a mixture of nonsmall cell lung cancer (typically squamous cell carcinoma or adenocarcinoma) and sarcomatous heterologous elements
  • Monoclonal tumor with divergent lines of differentiation, leading to mixture of carcinomatous and sarcomatous elements (Am J Surg Pathol 2002;26:510)
Essential features
  • Biphasic tumor consisting of a nonsmall cell carcinoma with heterologous sarcomatoid differentiation
  • Rare tumor with poor prognosis
  • Recommend molecular testing according to associated histologic components; i.e. tumors with adenocarcinoma component should be tested for EGFR and ALK (J Thorac Oncol 2015;10:1243)
Terminology
  • Use specific term "carcinosarcoma" rather than general term "sarcomatoid carcinoma" whenever possible to avoid confusion (J Thorac Oncol 2015;10:1243)
  • "Biphasic sarcomatoid carcinoma" has been proposed as replacement term
ICD coding
  • Use code specific for location of tumor
  • C34.90 malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
  • Rare, 0.1% of all lung cancers
  • M > F, most with smoking history, average age 60
Sites
  • Large airways and peripheral lung
Pathophysiology
  • Primary lung carcinoma undergoes sarcomatoid change
Etiology
  • Epithelial malignancy with divergent differentiation
Clinical features
  • Dependent on location: endobronchial lesions have pneumonia, cough, shortness of breath, hemoptysis; peripheral lesions may have no symptoms
Diagnosis
  • Difficult to diagnose on small biopsy / cytology but possible
Radiology images

Images hosted on other servers:
CT before / after targeted therapy CT before / after targeted therapy CT before / after targeted therapy

CT before / after targeted therapy

Large mass on CT scan

Large mass on CT scan

Mass lesion located left hilar localization

Mass lesion located left hilar localization

Prognostic factors
  • Poor prognosis overall; increased tumor size appears related to reduced survival (Am J Surg Pathol 1999;23:1514)
  • Better prognosis for smaller or endobronchial lesions
Case reports
Treatment
Gross description
  • May show central necrosis and hemorrhage if larger tumor
  • Irregular borders, tan to yellow
Gross images

Images hosted on other servers:
Bronchial carcinosarcoma

Bronchial carcinosarcoma

Microscopic (histologic) description
  • Mixture of carcinomatous and sarcomatous elements
  • Carcinoma component usually squamous but may be glandular or neuroendocrine
  • Heterologous sarcomatoid component, such as rhabdomyosarcoma, osteosarcoma, chondrosarcoma
  • Metastases may show carcinomatous or sarcomatous component or both
Microscopic (histologic) images
Scroll to see all images


Contributed by Yale Rosen, M.D. and Jian-Hua Qiao, M.D.
Giant cell carcinoma Giant cell carcinoma Giant cell carcinoma Giant cell carcinoma Giant cell carcinoma

Giant cell carcinoma

Core biopsy

Core biopsy


AE1 / AE3

AE1 / AE3

Cam 5.2

CAM 5.2



Images hosted on other servers:
Various images Various images Various images Various images

Various images

Initially presenting as invasive aspergillosis

Initially presenting as invasive aspergillosis

Blastomatoid variant

Blastomatoid variant


Lung parenchyma showing infiltration

Lung parenchyma showing infiltration

Lipoblastic elements with spindle cell component

Lipoblastic elements with spindle cell component

Adenocarcinoma with acinar growth pattern

Adenocarcinoma with acinar growth pattern

Malignant poorly formed epithelial glands

Malignant poorly formed epithelial glands

S100

S100

CK7 and TTF1

CK7 and TTF1


Carcinoma with atypical glands

Carcinoma with atypical glands

H&E

H&E

Virtual slides

Images hosted on other servers:
Rosai collection Rosai collection Rosai collection

Rosai collection

Cytology description
  • May only show epithelial component, i.e. squamous cell carcinoma
Cytology images

Contributed by Jian-Hua Qiao, M.D.
Highly pleomorphic giant cells Highly pleomorphic giant cells Highly pleomorphic giant cells Highly pleomorphic giant cells Highly pleomorphic giant cells Highly pleomorphic giant cells

Highly pleomorphic giant cells


Highly pleomorphic giant cells Highly pleomorphic giant cells Highly pleomorphic giant cells

Highly pleomorphic giant cells

Positive stains
  • Dependent on specific components of tumor
Negative stains
  • Dependent on specific components of tumor
Molecular / cytogenetics description
Differential diagnosis
Additional references
Board review style question #1
The most common epithelial component of a primary pulmonary carcinosarcoma is:

  1. Adenocarcinoma
  2. Adenosquamous carcinoma
  3. Large cell carcinoma
  4. Small cell carcinoma
  5. Squamous cell carcinoma
Board review answer #1
E. Squamous cell carcinoma
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