A 79-year-old man with a 40 pack-year smoking history presented with progressive right hip pain. During the two months prior to his admission, he noted generalized fatigue, poor appetite, and an unintentional weight loss of 20 pounds. Two weeks prior to admission, he began experiencing a constant pain in his right hip which radiated down his leg. He did not have fever, chills, low back pain, bladder incontinence, numbness or tingling. Physical examination was notable for diminished breath sounds over the left upper lung field and decreased strength of his right lower extremity secondary to pain. A chest x-ray showed a large left apical pleural-based mass. A subsequent computed tomography (CT) scan of the thorax revealed a 7.3-cm left upper lobe mass invading the chest wall. A biopsy confirmed a high-grade spindle cell neoplasm consistent with sarcomatoid carcinoma. A positron emission tomography (PET) scan showed metastatic lesions to the right iliac wing, ascending colon, and left suprahilar lymph nodes. Given his poor functional status, the patient was deemed not to be a candidate for surgery or chemotherapy; he opted for palliative radiation therapy to his right hip.
Pulmonary sarcomatoid carcinoma (PSC) is a rare histologic subtype of non-small cell lung cancer (NSCLC), accounting for less than 1% of all lung malignancies. PSCs are defined as poorly differentiated NSCLCs that contain a sarcomatous component or sarcoma-like element. Five subtypes are recognized by the World Health Organization: spindle cell carcinoma, giant cell carcinoma, pleomorphic carcinoma, carcinosarcoma, and pulmonary blastoma. The patients are usually male with a history of moderate to heavy tobacco consumption; mean age at diagnosis is between 65 and 75 years. PSCs commonly present as large (mean 7 cm) solitary peripheral masses with predilection for the upper lobes of the lung. Compared to other histologic subtypes, PSC behaves in an aggressive manner and tends to be a predictor of poor prognosis. In one retrospective study, the 5-year survival for PSC patients was 24.5% compared with 46.3% for NSCLC patients. Limited evidence currently exists supporting any particular treatment strategy. While surgical resection is likely associated with improved outcomes in early stage disease, several case series suggest high rates of resistance to conventional first-line chemotherapy.
While lung cancer remains one of the most common cancer types worldwide, pulmonary sarcomatoid carcinomas are rarely encountered in clinical practice and thus less recognized. They are believed to be more aggressive and are associated with poorer outcomes than typical non-small cell lung cancers.
To cite this abstract:Chung R, Bates J. Spindled Out of Control: A Rare, Aggressive Form of Lung Cancer. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 487. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/spindled-out-of-control-a-rare-aggressive-form-of-lung-cancer/. Accessed April 4, 2020.