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

Sarcomatoid carcinomas
- Negative staining for
  - Desmin
  - Caldesmon
  - Smooth muscle actin (SMA)
- May show focal areas of squamous differentiation

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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