Sarcomatoid carcinoma


Topic Completed: 1 September 2012

Minor changes: 11 June 2021

Copyright: 2003-2021,, Inc.

PubMed Search: pleomorphic carcinoma lung

Deepali Jain, M.D.
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Cite this page: Jain D. Pleomorphic. website. Accessed October 25th, 2021.
Definition / general
  • Subtype of sarcomatoid carcinoma; usually aggressive, malignant epithelial neoplasm composed of cells with significant cytologic atypia and nuclear pleomorphism
  • 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
  • < 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
  • 2-17 cm, necrosis and hemorrhage common
Microscopic (histologic) description
  • 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
  • Sarcomatoid component: CK7 (63%), TTF1 (43%), surfactant protein A (6%)
  • Epithelial component: CK7 (76%), TTF1 (59%), surfactant protein A (39%)
Negative stains
  • CK20
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