Evaluation of Six Patients with Pulmonary Carcinosarcoma with a Literature Review

The Scientific World Journal Volume 2012, Article ID 167317, 5 pages doi:10.1100/2012/167317 The cientificWorldJOURNAL Review Article Evaluation of Six Patients with Pulmonary Carcinosarcoma with a Literature Review Sinem Nedime Sökücü,1 Celalettin Kocatürk,2 Nur Ürer,3 Yaşar Sönmezoğlu,2 Levent Dalar,1 Levent Karasulu,1 Sedat Altın,1 and Mehmet Ali Bedirhan2 1 Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Zeytinburnu, 34760 İstanbul, Turkey 2 Department of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Zeytinburnu, 34760 İstanbul, Turkey 3 Department of Pathology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Zeytinburnu, 34760 İstanbul, Turkey Correspondence should be addressed to Sinem Nedime Sökücü, Received 11 October 2011; Accepted 2 January 2012 Academic Editors: E. Briasoulis, B. L. Lum, A. Paulino, and G. Storme Copyright © 2012 Sinem Nedime Sökücü et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Carcinosarcoma of the lung is a rare malignant neoplasm. We evaluated the diagnosis and treatment of six carcinosarcoma cases, including a synchronous tumour and a solitary pulmonary tumour, along with the clinical and histological features and survival times. Methods. From a retrospective analysis of 1076 non-small-cell lung cancer resections performed between January 1996 and January 2011, six patients (0.5%) with pulmonary carcinosarcoma (all males; mean age 58 years; range 53–66) who underwent surgical treatment were studied. Results. The mean tumour pathological T diameter was 7.2 cm (median 6 cm, range 3–14.5 cm). Only one patient was diagnosed with carcinosarcoma preoperatively. The clinical presentation and tumour localisations differed. The operations performed were a lobectomy (n = 4), pneumonectomy (n = 1), and bilobectomy (n = 1). Histologically, the epithelial characteristics of the tumours were consistent with squamous cell carcinoma in most of the patients. A complete resection was performed in all six patients. No mortality occurred in the early postoperative period. The median survival time was 9 (3–25) months. Conclusion. The preoperative diagnosis of carcinosarcoma of the lung is difficult due to the composition of the different histopathological structures. Complete surgical resection is the treatment of choice for pulmonary carcinosarcoma, although further studies are needed. 1. Introduction 2. Material and Method Pulmonary carcinosarcoma (PCS) is a rare tumour in humans [1, 2]. It was first defined by Kika et al. in 1908 as a poorly differentiated non-small-cell carcinoma containing a component with sarcoma or sarcoma-like features [3]. It accounts for 0.3 to 1% of all pulmonary cancers, and its clinical characteristics, preoperative diagnostic methods, and prognostic factors are still not completely understood [4]. Pulmonary carcinosarcomas occur predominantly in elderly men and middle-aged smokers [5]. This study evaluated the results of six cases who underwent surgery for PCS. This was a retrospective study of six patients who underwent surgery for pulmonary tumours in our chest surgery clinic between January 1996 and January 2011 and who had a postoperative diagnosis of PCS. The patients were evaluated in terms of their age, gender, symptoms, diagnostic approaches, surgical methods, and followup findings. All of the patients underwent routine laboratory studies, respiratory function tests, electrocardiography, chest X-ray, computed tomography (CT) of the thorax, brain CT or magnetic resonance imaging (MRI), abdominal ultrasound, 2 The Scientific World Journal Table 1: Characteristics of the patients. Patient Age Cigar (pack years) Symptoms Endobronchial Component Localization Diameter (cm) CT/surgical Preoperative diagnosis 1 63 90 Cough hemoptysis Yes Right lower lobe 3/3 NSCLC (epidermoid) 2 66 40 Chest pain, Hemoptysis Cough Yes Right central 8/10 NSCLC with neuroendocrine differantiation 3 54 60 Hemoptysis Chest pain Cough No Right hiler intermediate Bronch 5/6,5 Carcinosarcoma 4 53 50 Hemoptysis Chest pain Cough No Left lower lobe 10/14,5 NSCLC 5 55 30 — No Left upper lobe 3/3,7 None 40 Chest pain Dyspnea No Left lower lobe 3,7/5,5 NSCLC 6 56 NSCLC: Non-small-cell lung carcinoma. Figure 1: Chest X-ray of a patient showing a mass lesion located left hiler localization. and bronchoscopy. Three patients underwent positron emission tomography (PET)-CT. In the preoperative period, one patient without a cancer diagnosis was suspected of having lung cancer, and one patient had a diagnosis of carcinosarcoma, whereas the other four patients were diagnosed with non-small-cell lung cancer (NSCLC). The patient who had a preoperative diagnosis of carcinosarcoma had an endobronchial component and was diagnosed by bronchoscopy. The mediastinal lymph nodes were evaluated by mediastinoscopy in all but one patient. A standard posterolateral thoracotomy incision and intraoperative staging were done in all patients. Complete resection was done in all patients. All of the tumours were staged postoperatively according to the seventh international TNM staging system. The diagnosis was verified immunohistochemically. All patients underwent clinical and radiological followup for a median of 7.5 (range 3–25) months. All patients were assessed quarterly for the first 2 years with a history, physical examination, and chest X-ray. Laboratory tests and advanced radiological methods were requested if there were any symptoms. Additionally, all patients or the families were asked by phone when the study was performed and asked about any signs of recurrence or complications. The statistical analysis was done using SPSS ver. 11.5. Descriptive analyses and Kaplan-Meier survival analysis were used. 3. Results All six patients were male and heavy smokers (mean 52 packs/year (median 45, range 30–90)), with a median age of 56 (range 53–66) years. The most common presenting symptom was cough (Table 1). Two of the tumours were located peripherally, three were located centrally (Figure 1), and the sixth had components in both areas. The diagnosis was made by fine-needle aspiration biopsy in two patients and by fibre optic bronchoscopy in three patients. Three of the six patients underwent PETCT. In these patients, pathological uptake was detected in the tumours, but no mediastinal involvement was detected. The operations performed were a pneumonectomy (due to The Scientific World Journal 3 Table 2: Diagnostic characteristics of the lesions. TNM Stage Cellular components of end diagnosis Resection Followup time (m) Prognosis 1 T3N0M0 IIB Squamous Chondrosarcoma Right Lo (...truncated)