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Lung tumor

Other Carcinoma

Pleomorphic carcinoma


Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 22 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Subtype of sarcomatoid carcinoma; usually aggressive, malignant epithelial neoplasm composed of cells with significant cytologic atypia and nuclear pleomorphism (WHO)
● Contains at least 10% spindle cells and/or giant cells
● Included under recent WHO classification of “carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements”

Clinical features
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● <1% of all carcinomas
● Mean age 65 years, range 42-81 years, >90% men, 92% smokers
● Presumed epithelial origin, although epithelial and sarcomatous components express common markers differently (Am J Surg Pathol 2003;27:1203)
● Classified as carcinomas despite presence of sarcomatoid features (Arch Pathol Lab Med 2010;134:1645)
● Nodal metastases common
● Stage 1 tumors have same prognosis as other stage 1 non-small cell carcinomas; at higher stages, may have worse prognosis than other non-small cell carcinomas of similar stage (Am J Surg Pathol 2003;27:311)
● Giant cell tumors frequently metastasize to small intestine

Gross description
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● 2-17 cm, necrosis and hemorrhage common

Micro description
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● Non small cell lung carcinoma with at least 10% neoplastic spindle or giant cells, usually with epithelial cells
● Epithelial component 10-85%, usually adenocarcinoma or large cell carcinoma, also squamous cell carcinoma (Am J Surg Pathol 2008;32:1727)
● Usually poorly differentiated
● Spindle cells resemble MPNST, MFH or fibrosarcoma
● Giant cells usually bizarre with multilobulated nuclei, abundant eosinophilic cytoplasm accompanied by heavy neutrophilic infiltrate with occasional ingested white blood cells
● Stroma often myxoid, frequent inflammatory infiltrate, collagen fibers
● Numerous mitotic figures
● Massive necrosis common
● Vascular invasion in 58%

Positive stains
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Sarcomatoid component - CK7 (63%), TTF1 (43%), surfactant protein A (6%)
Epithelial component - CK7 (76%), TTF1 (59%), surfactant protein A (39%)

Negative stains
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● CK20

End of Lung tumor > Other carcinoma > Pleomorphic carcinoma


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