Primary sarcomatoid carcinoma of lung

Case contributed by Dr Shimalis Tadasa Fayisa

Presentation

Right chest pain. Generalized weakness and weight loss for 6 months.

Patient Data

Age: 75 years
Gender: Male
  • large right lower lobe lung mass that measures 10.5 x 12.8 x 11.2 cm. It has a round form with a sharp border that touches the parietal pleura. It has a heterogeneous density with a core fluid and peripheral soft tissue density.  After a post contrast examination, the peripheral soft tissue component enhances with a non enhancing central necrotic center
  • right side minimal pleural fluid collection
  • adjacent little area lung consolidation visible in the superior aspect of the mass
  • bilateral heterogeneously enhancing adrenal mass measuring 3.6 x 2.1 x 2.4cm in the right and 3.2 x 3.1 x 2.7cm on the left
  • small enhancing soft tissue mass with modest epidural fat effacement is visible near the posterior region of the T9 vertebral body, possibly indicating metastasis to the vertebra
  • T12 vertebral burst fracture

Adrenal protocol

CT

Bilateral adrenal masses exhibiting increasing contrast filling with no evidence of contrast washout consistent with adrenal metastases.

Case Discussion

Primary sarcomatoid lung carcinoma is a non small cell lung carcinoma that makes for 0.4% of all lung cancer cases. Compared to other non sarcomatoid lung cancers, it has a worse prognosis.

Due to its rarity, it is challenging to investigate this category of cancers, and from the literature that is accessible, it appears that it is more common in men and smokers after the age of 60.

On imaging, they frequently show up as a circular, well-defined, massive mass with a hemorrhagic and necrotic center. Metastasis is thought to spread by lymphatic and hematologic routes. It will spread to the brain, bone, liver, and adrenal glands just like other types of lung cancer.

According to a biopsy that was done under ultrasound guidance, the aforementioned instance is a primary sarcomatoid carcinoma of the lung. with vertebral and bilateral adrenal metastasis.

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