Lung tumor
Sarcomatoid carcinoma

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

Topic Completed: 1 May 2017

Minor changes: 27 December 2019

Copyright: 2003-2019,, Inc.

PubMed Search: Carcinosarcoma [title] lung

Roseann Wu, M.D., M.P.H.
Page views in 2019: 3,879
Page views in 2020 to date: 3,148
Cite this page: Wu R. Carcinosarcoma. website. Accessed August 12th, 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)
  • 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
  • Rare, 0.1% of all lung cancers
  • M > F, most with smoking history, average age 60
  • Large airways and peripheral lung
  • Primary lung carcinoma undergoes sarcomatoid change
  • 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
  • Difficult to diagnose on small biopsy / cytology but possible
Radiology images

Images hosted on other servers:

CT before / after targeted therapy:

Large mass on CT scan

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
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

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

Images hosted on other servers:

Images on Flickr

Core biopsy, Flickr

AE1 / AE3, Flickr

CAM5.2, Flickr

Various images

Initially presenting
as invasive

Blastomatoid variant

Lung parenchyma

Lipoblastic elements
with spindle cell

Adenocarcinoma with acinar growth pattern

Malignant poorly formed epithelial glands


CK7 and TTF1

Carcinoma with atypical glands (mag ×20)

H&E magnification 40× and 400×

Virtual slides

Images hosted on other servers:

Rosai collection

University of Michigan

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

Images hosted on other servers:

Images on Flickr

Images on Flickr

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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