Carcinosarcoma
Key Facts
Terminology
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Malignant biphasic neoplasm composed of malignant epithelial and malignant mesenchymal components
Etiology/Pathogenesis
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Carcinosarcomas have been linked to tobacco use
Clinical Issues
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More common in men than women
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May be central or peripheral
Macroscopic Features
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Central tumors may grow in polypoid fashion, obstructing airways
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Peripheral tumors may reach large size
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Areas of necrosis &/or hemorrhage are common
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2 cm to > 10 cm in diameter
Microscopic Pathology
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Biphasic
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Presence of conventional carcinoma (any type) with sarcoma (any type)
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Squamous cell carcinoma is most common epithelial component
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Epithelial, biphasic, or mixed
Top Differential Diagnoses
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Carcinoma
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In small biopsy specimen where only epithelial component is present
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Sarcoma
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In small biopsy specimen where only sarcomatous component is present
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Gross photograph of pulmonary carcinosarcoma shows a well-circumscribed, light tan, fleshy intrapulmonary mass. Note the absence of necrosis and hemorrhage. |
Primary carcinosarcoma of the lung shows classical features of squamous cell carcinoma  and rhabdomyosarcoma  . |
TERMINOLOGY
Abbreviations
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Carcinosarcoma (CSC)
Definitions
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Malignant biphasic neoplasm composed of malignant epithelial and malignant mesenchymal components
ETIOLOGY/PATHOGENESIS
Environmental Exposure
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Carcinosarcomas have been linked to tobacco smoke
Etiology
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Collision tumor
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Composite tumor
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Tumor derived from stem cells with multiple differentiation
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Biphasic sarcomatoid carcinomas
CLINICAL ISSUES
Epidemiology
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Incidence
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More common in men than women
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Site
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May be central or peripheral
Presentation
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Cough
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Dyspnea
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Hemoptysis
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Chest pain
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Weight loss
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Obstructive pneumonia
Treatment
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Surgical approaches
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Complete resection
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Adjuvant therapy
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No definitive specific treatment
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Prognosis
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Poor
MACROSCOPIC FEATURES
General Features
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Central tumors may grow in polypoid fashion, obstructing airway
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Peripheral tumors may reach large size
-
Areas of necrosis &/or hemorrhage are common
Size
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2 cm to > 10 cm in diameter
MICROSCOPIC PATHOLOGY
Histologic Features
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Presence of conventional carcinoma (any type) with sarcoma (any type)
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Squamous cell carcinoma is most common epithelial component
Predominant Pattern/Injury Type
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Biphasic
Predominant Cell/Compartment Type
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Epithelial, biphasic, or mixed
DIFFERENTIAL DIAGNOSIS
Carcinoma
Sarcoma
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In small biopsies if only component is mesenchymal
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In larger specimens, presence of any heterologous sarcomatous component in association with carcinoma is diagnostic
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