Pleomorphic Carcinoma

Pleomorphic Carcinoma
Key Facts
Terminology
  • Malignant epithelial neoplasm composed of spindle and multinucleated giant cells in different proportions
Etiology/Pathogenesis
  • PC may represent a genetically distinct type of malignancy separate from squamous and adenocarcinoma
Clinical Issues
  • Symptoms
    • Chest pain
    • Hemoptysis
    • Cough
  • Prognosis
    • Majority of cases are in advanced clinical stages
    • Prognosis is poor
  • Lobectomy or pneumonectomy
  • Chemotherapy or radiation therapy depending on clinical setting
Microscopic Pathology
  • Mixture of 2 distinct components, sarcomatoid and giant cells
Top Differential Diagnoses
  • Malignant fibrous histiocytoma (MFH)
  • Pulmonary leiomyosarcoma
  • Sarcomatoid carcinoma
  • Metastatic choriocarcinoma
Gross photograph of pleomorphic carcinoma of the lung shows a large centrally located malignant neoplasm. The tumor shows a smooth cut surface and focal necrosis image.
Pleomorphic carcinoma of the lung shows a cellular proliferation composed of spindle and large multinucleated giant cells. The tumor appears well circumscribed but not encapsulated.
TERMINOLOGY
Abbreviations
  • Pleomorphic carcinoma (PC)
Synonyms
  • Giant cell carcinoma, carcinoma with giant cells, carcinoma with pseudosarcomatous stroma, pseudosarcomatous carcinoma, metaplastic carcinoma
Definitions
  • Malignant epithelial neoplasm composed of spindle and multinucleated giant cells in different proportions
ETIOLOGY/PATHOGENESIS
Etiology
  • PC may represent a genetically distinct type of malignancy separate from squamous cell carcinoma and adenocarcinoma
CLINICAL ISSUES
Presentation
  • Asymptomatic
  • Chest pain
  • Hemoptysis
  • Cough
Treatment
  • Surgical approaches
    • Lobectomy or pneumonectomy
  • Adjuvant therapy
    • Chemotherapy or radiation therapy depending on clinical setting
Prognosis
  • Depends on stage at diagnosis
  • Majority of cases are in advanced clinical stages
  • Prognosis is poor
MACROSCOPIC FEATURES
General Features
  • Central or peripheral
  • Varying size but generally large tumors
  • Well circumscribed but not encapsulated
  • Light tan with homogeneous cut surface
    • Areas of necrosis &/or hemorrhage may be seen
MICROSCOPIC PATHOLOGY
Histologic Features
  • Mixture of 2 distinct components, spindle and giant cells
Predominant Pattern/Injury Type
  • Sarcomatoid
Predominant Cell/Compartment Type
  • Epithelial
DIFFERENTIAL DIAGNOSIS
Malignant Fibrous Histiocytoma (MFH)
  • Touton-type giant cells in MFH; multinucleated malignant cells in PC
  • Areas of squamous cell carcinoma or adenocarcinoma in most cases of PC
  • Studies using keratin antibodies helpful as sarcomatoid component may show keratin expression
    • MFH may also show focal positive staining for keratin
Pulmonary Leiomyosarcoma
  • Immunohistochemistry studies for desmin, caldesmon, and SMA generally negative in PC cases while positive in leiomyosarcomas
  • Presence of multinucleated giant cell component is not a common feature, even in cases of high-grade leiomyosarcoma
  • Most pulmonary leiomyosarcomas are confined to lung, while PC is commonly in advanced clinical stage
Sarcomatoid Carcinoma
  • Though sarcomatoid carcinoma and PC are often coded under same category, PC has sarcomatoid component in association with multinucleated giant cells
  • Sarcomatoid carcinoma shows only spindle cell component
  • Both tumors share similar immunohistochemical profile
Tags:
Jul 9, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Pleomorphic Carcinoma

Full access? Get Clinical Tree
Get Clinical Tree app for offline access