Sarcomatoid carcinoma of lung- rare but dangerous histology - A case series

 

 

Abstract              Sarcomatoid carcinoma of lung, a rare variant of poorly differentiated non-small cell carcinoma of lung, is found to have an aggressive clinical course thus projecting very poor prognosis. Recent advances in pathology including immunohistochemical studies have improved the chance of diagnosis of these variants. The case series has been reported due to the rarity of the disease and inadequate treatment recommendations. Four cases presented in our department diagnosed with this tumor during the period January 2015 to December 2018 with varied clinical and diagnostic features. The first patient presented with inoperable disease staged IIIC which later further progressed with rib metastasis despite chemotherapy showing increased aggressiveness. The second patient also diagnosed with metastatic disease showed ALK positivity hence was treated with crizotinib, showing partial response to treatment with close monitoring. The third and fourth patients were operable hence treated with surgery followed by cisplatin based chemotherapy and radiation. The third patient succumbed to the disease and the fourth patient is on regular follow up for 4 months. All the patients were male and above 40 years of age predominantly presenting with advanced stages, three of them being chronic smokers. All patients had a pathological diagnosis of sarcomatoid carcinoma with a supporting immunohistochemistry of vimentin and CK positivity. The rarity, rapid progression and short survival with heterogenous pathological qualities of this disease have made it difficult to formulate proper treatment recommendations. Further prospective studies are required to further define the role and efficacy of chemotherapy and targeted agents in this disease.

Key Word: sarcomatoid carcinoma, lung, aggressive variant, rapid progression, vimentin