Lung

Sarcomatoid carcinoma

Pleomorphic carcinoma



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PubMed Search: Pleomorphic carcinoma lung

Roseann Wu, M.D., M.P.H.
Deepali Jain, M.D.
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Cite this page: Wu R, Jain D. Pleomorphic carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lungtumorpleomorphic.html. Accessed December 3rd, 2022.
Definition / general
  • Pleomorphic carcinoma:
    • 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"
  • Giant cell carcinoma:
    • Subtype of sarcomatoid carcinoma consisting of purely giant, pleomorphic tumor cells
    • Should not show differentiated non small cell components
    • Tumor stains for cytokeratins
  • Spindle cell carcinoma:
    • Subtype of sarcomatoid carcinoma (WHO)
    • < 1% of all primary lung carcinomas
Essential features
  • Giant cell carcinoma:
    • Classified as a subtype of sarcomatoid carcinoma that is composed almost entirely of tumor giant cells with no differentiated carcinomatous elements
    • Tumor giant cells may or may not stain for human chorionic gonadotrophin
    • Metastatic sarcoma or germ cell tumor should be excluded
Terminology
ICD coding
  • Giant cell carcinoma:
    • Use code specific for location of tumor
    • ICD-10: C34.90 - malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
  • Pure giant cell carcinoma is rare, 0.3 - 2% of lung cancers
  • Mean age: 65 years, range: 42 - 81 years
  • > 90% men, 92% smokers
Sites
  • Giant cell carcinoma:
    • May show predilection for upper lobes
    • Giant cell tumors frequently metastasize to small intestine
Pathophysiology
  • Giant cell carcinoma: may have increased incidence of gastrointestinal tract involvement (Cancer 1992;70:606)
Etiology
  • Giant cell carcinoma: appears to be a morphologic phenotype expressed by a heterogeneous group of tumors (Histopathology 1998;32:225)
Clinical features
  • Pleomorphic carcinoma:
  • Giant cell carcinoma:
    • Cough, chest pain, dyspnea, malaise (varies by location)
Diagnosis
  • Giant cell carcinoma: cannot be made on small biopsies or cytology; definite diagnosis only on resected tumor
Radiology images

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CT of lung nodule

CT of lung nodule

Prognostic factors
  • Giant cell carcinoma:
  • Pleomorphic carcinoma:
    • 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)
Case reports
Treatment
  • Giant cell carcinoma: not usually surgical since metastatic at diagnosis but resection and radiation may prolong survival
Clinical images

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Endobronchial tumor

Endobronchial tumor

Gross description
  • Pleomorphic carcinoma:
    • 2 - 17 cm, necrosis and hemorrhage common
  • Giant cell carcinoma:
    • Solid, well demarcated, tan, peripheral mass with areas of necrosis and hemorrhage
Gross images

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8 x 7 cm tumor

8 x 7 cm tumor

Microscopic (histologic) description
  • Pleomorphic carcinoma:
    • 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%
  • Giant cell carcinoma:
    • Dyscohesive, polygonal, mono and multinucleated giant cells with abundant cytoplasm and prominent nucleoli
    • Neoplastic, highly pleomorphic giant cells, often in inflammatory stroma with emperipolesis (Arch Pathol Lab Med 2010;134:1645)
    • Giant cells are multinucleated, may resemble syncytiotrophoblasts and produce human chorionic gonadotropin but are usually fewer than in primary choriocarcinoma of lung (Histopathology 2000;36:17)
    • 2 types of giant cells: βHCG positive syncytiotrophoblast-like giant cells with smudged nuclei and coarse chromatin with nuclear molding and βHCG negative giant cells with admixed neutrophils and cell in cell features (Histopathology 2016;68:680)
  • Spindle cell carcinoma:
    • Carcinoma composed exclusively of spindle shaped tumor cells
    • Tumor cells often obliterate vessels
Microscopic (histologic) images

Contributed by Roseann Wu, M.D., M.P.H.
Giant cell CA lung HE

Giant cell CA lung HE

Giant cell CA LUNG HE

Giant cell CA lung HE



Images hosted on other servers:
8 x 7 cm tumor

8 x 7 cm tumor

Diffuse proliferation of atypical, giant and bizarre cells

Diffuse proliferation of atypical, giant and bizarre cells

Virtual slides

Images hosted on other servers:
Giant cell carcinoma - Rosai collection Giant cell carcinoma - Rosai collection Giant cell carcinoma - Rosai collection Giant cell carcinoma - Rosai collection

Giant cell carcinoma


Giant cell carcinoma - Rosai collection Giant cell carcinoma - Rosai collection Giant cell carcinoma - Rosai collection

Giant cell carcinoma

Cytology description
  • Giant cell carcinoma:
    • Pleomorphic cells in flat loose clusters, with abundant, thick, well demarcated cytoplasm, multinucleation (Acta Cytol 2011;55:173)
    • Sharp clear nuclear membranes, acidophilic cytoplasm with finely granular or foamy appearance, irregular coarse chromatin, bizarre mitoses, neutrophil engulfment (Diagn Cytopathol 2007;35:555)
Cytology images

Contributed by Roseann Wu, M.D., M.P.H.
Giant cell CA ThinPrep

Giant cell CA ThinPrep

Positive stains
  • Pleomorphic carcinoma:
    • Sarcomatoid component: CK7 (63%), TTF1 (43%), surfactant protein A (6%)
    • Epithelial component: CK7 (76%), TTF1 (59%), surfactant protein A (39%)
  • Giant cell carcinoma:
Negative stains
Differential diagnosis
Board review style question #1
Giant cell carcinoma of the lung is most commonly associated with which epithelial component resembling non small cell carcinoma?

  1. Adenocarcinoma
  2. Adenosquamous carcinoma
  3. Large cell carcinoma
  4. Squamous cell carcinoma
  5. None of the above
Board review style answer #1
E. None of the above. Giant cell carcinoma is a subtype of sarcomatoid carcinoma composed almost entirely of tumor giant cells with no differentiated carcinomatous elements.

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