"Diagnostic Challenges in a Cavitary Pulmonary Sarcomatoid Carcinoma Wi" by Mitchell Smielewski and Faizan Faizee
 

Diagnostic Challenges in a Cavitary Pulmonary Sarcomatoid Carcinoma With Vascular Invasion

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Pulmonary sarcomatoid carcinoma (PSC) represents a rare subset of non-small cell lung cancer with distinct histological variants including spindle cell and pleomorphic carcinoma. The differentiation between these subtypes presents significant diagnostic challenges, often requiring complete mass resection rather than limited tissue sampling. Case Presentation: A 71-year-old woman with a 55-pack-year smoking history presented with a three-month history of persistent dry cough and right-sided chest pain refractory to outpatient antibiotic therapy. Computed tomography revealed a 7.6 x 8.4 cm cavitary lesion in the right lower lobe (RLL) with chest wall invasion and pathologic rib fractures. Initial bronchoscopy was non-diagnostic. Subsequently, she developed progressive dyspnea, and repeat imaging demonstrated a large right pleural effusion with intrapulmonary shunting on transthoracic echo due to vascular invasion of the cavitary mass. Video-assisted thoracoscopic surgery (VATS) with chest wall biopsy suggested either pleomorphic or spindle cell carcinoma. Further staging revealed stage IV disease with brain metastases. The patient declined therapeutic intervention and opted for hospice care. Discussion: This case describes the diagnostic complexity and aggressive biological behavior of pulmonary sarcomatoid carcinoma. Pleomorphic carcinoma encompasses undifferentiated non-small cell components with possible spindle or giant cells, while spindle cell carcinoma demonstrates pure spindle cell morphology. Further, the presence of intrapulmonary shunting in our case suggests extensive vascular invasion and highlights the tumor's aggressive angioinvasive properties. While surgical resection remains the cornerstone of treatment in localized disease, the optimal therapeutic approach for metastatic PSC remains undefined. Research studies have identified potential therapeutic targets, such as PD-L1 inhibitor, suggesting a possible role for immune checkpoint inhibition. However, the rarity of PSC has precluded large-scale clinical trials, leaving a significant gap in evidence-based treatment algorithms. This case contributes to the limited literature on PSC and emphasizes the critical need for established treatment protocols and early detection strategies.

Volume

211

First Page

A2786

Comments

American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA

Last Page

A2786

DOI

10.1164/ajrccm.2025.211.Abstracts.A2786

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