Pleomorphic carcinoma of lung

Last revised by Dr Bruno Di Muzio on 02 Aug 2021

Pleomorphic carcinomas of the lung are a rare type of non-small cell lung carcinomas (NSCLC) classified under sarcomatoid carcinomas of the lungs.

These tumors are thought to account for 0.1-0.4% of all lung malignancies.

There is a recognized association with smoking.

Histologically, a pleomorphic carcinoma is defined as either: 

At least 10% of the carcinoma should comprise spindle and/or giant cells for it to be classified as a pleomorphic carcinoma.

There no published specific imaging features for this histological subtype. Most CT features are thought to be dependent on the epithelial component of the tumor 5.

The tumors can be either endobronchial (central) or peripheral (the latter location is considered commoner 1,7). They can frequently involve the pleural and/or chest wall. Larger tumors may show central low attenuation. Some publications suggest an upper lobe predilection 5. While many can be well-defined, some can be lobulated, ill-defined or even spiculated 5.

A spindle cell histology is generally associated with a more aggressive clinical course 3,4. The presence of pleural invasion is associated with a much worse prognosis 7.

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