Spindle Cell (Sarcomatoid) Carcinoma
Key Facts
Terminology
Carcinoma with pseudosarcomatous component, pseudosarcomatous carcinoma, spindle cell carcinoma
Clinical Issues
Cough
Chest pain
Hemoptysis
Macroscopic Features
Central or peripheral tumors
2 to > 10 cm in diameter
Firm, light tan, and well-circumscribed but not encapsulated
Areas of necrosis may be seen
Microscopic Pathology
Tumor composed exclusively of malignant spindle cells
Top Differential Diagnoses
Pleomorphic carcinoma (PC)
In addition to spindle cell component, PC should have presence of multinucleated giant cells
Leiomyosarcoma: Sarcomatoid carcinoma
Should have negative staining for desmin, caldesmon, or SMA
May show focal areas of squamous differentiation
Malignant fibrous histiocytoma
Absence of immunoreactivity for epithelial markers
 Gross photograph shows an intrapulmonary large mass that is white, firm, and well circumscribed. The cut surface is smooth and homogeneous. |
 Centrally located spindle cell (sarcomatoid) carcinoma shows a tumor with solid and diffuse malignant cellular proliferation. |
TERMINOLOGY
Synonyms
Carcinoma with pseudosarcomatous component, pseudosarcomatous carcinoma, spindle cell carcinoma
Definitions
Malignant epithelial neoplasm composed of spindle cells
ETIOLOGY/PATHOGENESIS
Etiology
Sarcomatoid carcinomas may represent poorly differentiated squamous cell carcinomas
CLINICAL ISSUES
Epidemiology
Incidence
Sarcomatoid carcinomas account for a small percentage of primary lung neoplasms
Age
Similar to other non-small cell carcinomas
Gender
No gender predilection
Presentation
Cough
Chest pain
Hemoptysis
Difficulty breathing
Treatment
Surgical approaches
Lobectomy or pneumonectomy
Adjuvant therapy
Chemotherapy &/or radiation therapy
Prognosis
Depends on stage at time of diagnosis
MACROSCOPIC FEATURES
General Features
Central or peripheral tumors
2 to > 10 cm in diameter
Firm, light tan, and well-circumscribed but not encapsulated
Areas of necrosis may be seen
MICROSCOPIC PATHOLOGY
Histologic Features
Tumor composed exclusively of malignant spindle cells
In some cases, focal areas of classic squamous cell carcinoma may be seen Predominant Pattern/Injury Type
Sarcomatoid Predominant Cell/Compartment Type
Epithelial
DIFFERENTIAL DIAGNOSIS
Pleomorphic Carcinoma (PC)
In addition to spindle cell component, PC should have presence of multinucleated giant cells
PC and sarcomatoid carcinoma share similar immunohistochemical profile
Leiomyosarcoma
Malignant Fibrous Histiocytoma
Absence of immunoreactivity for epithelial markers
DIAGNOSTIC CHECKLIST
Pathologic Interpretation Pearls
Tumor composed exclusively of malignant spindle cells
SELECTED REFERENCES
1. Chhatwani L et al: Adjuvant treatment of resected lung cancer. Proc Am Thorac Soc. 6(2):194-200, 2009
2. Rossi G et al: A reevaluation of the clinical significance of histological subtyping of non—small-cell lung carcinoma: diagnostic algorithms in the era of personalized treatments. Int J Surg Pathol. 17(3):206-18, 2009
3. Stinchcombe TE et al: Current treatments for advanced stage non-small cell lung cancer. Proc Am Thorac Soc. 6(2):233-41, 2009
4. Ro JY et al: Sarcomatoid carcinoma of the lung. Immunohistochemical and ultrastructural studies of 14 cases. Cancer. 69(2):376-86, 1992
5. Matsui K et al: Spindle cell carcinoma of the lung. A clinicopathologic study of three cases. Cancer. 67(9):2361-7, 1991
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