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Sarcomatoid Carcinomas

Sarcomatoid Carcinomas. Dr. Serpil Dizbay Sak. A group of poorly differantiated non-small cell lung carcinomas Common denominator Sarcoma or sarcoma like differentiation. Epithelial Squamous cells Glands Indiffferentiated epithelial cells Small neuroendocrine cells. Non-epithelial

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Sarcomatoid Carcinomas

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  1. SarcomatoidCarcinomas Dr. Serpil Dizbay Sak

  2. A group of poorly differantiated non-small cell lung carcinomas • Common denominator • Sarcoma or sarcoma like differentiation

  3. Epithelial Squamous cells Glands Indiffferentiated epithelial cells Small neuroendocrine cells Non-epithelial Spindle cells Giant cells Sarcoma component Muscle Bone Cartilage Morphologic components in lung carcinomas

  4. Non-epithelial components in lung carcinoma • Described by Kika (1908) • Barbarkos (1985): 49 cases

  5. Terminology • sarcomatoid carcinoma • pleomorphic carcinoma • giant cell carcinoma • spindle cell carcinoma • biphasick lung tumor • pseudosarcomatous carcinoma • carcinosarcoma • pseudosarcoma • ...............

  6. I. Epithelial tumors Benign Displasia-carcinoma in situ C. Malignant 1.Squamous cell ca. -spindle cell carcinoma 4. Large cell ca. -giant cell carcinoma II.Tumors of the soft tissue III.Mesothelial tumors IV. Miscelleneous tumors 1.carcinosarcoma 2.pulmonary blastoma 3........... WHO (1981)

  7. Pleomorphic sarcomatoid ve sarcomatous elemanlar içeren carcinomas (WHO 99) a. Carcinomas with spindle and/or giant cells 1.pleomorphic carcinoma 2.spindle cell carcinoma 3.giant cell carcinoma b.carcinosarcoma c.pulmonary blastoma

  8. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastoma

  9. General features Age:60 M/F:4/1 Pulmonary blastoma: M/F:1/1 Fourth decade Smoking Asbestosis Epidemiological and Ethiological Features

  10. sarcomatoid carcinomas: rare tumors • Within all lung carcinomas • 0.3- 1.3 % • A spindle cell tumor in lung • Most likely a sarcomatoid carcinoma

  11. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastomaa

  12. Ankara University School of Medicine 2000-2006 March • 26 cases • 23M; 3F • Age: 43-78 • 61.1

  13. Epithelial component adenocarcinoma: 12 squamous: 8 large cell: 2 sarcomatoid component giant cell:15 spindle:18 26 cases

  14. 26 Cases • 1: single component (giant cell) • 19: two components • 5: three components • 1: four componets

  15. Typical cells of sarcomatoid carcinoma • spindle cells • giant cells • These cells should be malignant!!

  16. CD68 CD68 Keratin

  17. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastoma

  18. Non-small cell carcinoma squamous cell adeno large cell neuroendocrine differentiation spindle cell carcinoma giant cell carcinoma pleomorphic carcinoma 10 % minimum

  19. WHO

  20. WHO

  21. WHO

  22. Non-small cell carcinoma squamous cell adeno large cell spindle cell carcinoma giant cell carcinoma pleomorphic carcinoma

  23. Non-small cell carcinoma squamous cell adeno large cell spindle cell carcinoma giant cell carcinoma pleomorphic carcinoma

  24. Non-small cell carcinoma squamous cell adeno large cell spindle cell carcinoma giant cell carcinoma pleomorphic carcinoma

  25. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastoma

  26. spindle cell carcinoma • A lung carcinoma with only spindle cells • Malignant spindle cells forming: • Cohesive islands • Fascicles • Storiform organization • A prominent lymphoplasmacytic infiltration • (Inflammotory sarcomatoid carcinoma Wick, 1995)

  27. spindle cell carcinoma • Epithelial differentiation • Absent by HE • Can be demonstrated by • İmmunohistochemistry • EM

  28. Inflammatory sarcomatoid carcinoma • Moderate pleomorphism • Spindle cells • Organization • Fascicular • Storiphorm • Can have mixoid areas

  29. Keratin

  30. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastoma

  31. giant cell carcinoma • pleomorphic mono/multinuclear giant cells • large, multilobulated, discohesive cells • No additional component

  32. WHO

  33. giant cell carcinoma • İnflammation with prominant neutrophile leucocytes • Within the tumor cells • Phagocytosis? • Emperipolesis?

  34. TTF1

  35. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastomaa

  36. carcinoma (non-small cell) squamous cell 70 % adeno 20-30 % large cell %10 Differantiated sarcoma Malignant cartilage Malignant bone Malignant muscle carcinosarcoma &

  37. WHO

  38. WHO

  39. carcinosarcoma • Sarcomatous component is more prominent in most cases: • carcinoma component must be searched • Sarcoma may consist of indifferantiated ‘spindle’ cells in most areas: • Differantiated sarcoma component must be searched

  40. carcinosarcoma • In metastases • Both components • Or • carcinoma only • Sarcoma only

  41. sarcomatoid carcinoma (WHO 2004) • pleomorphic carcinoma • spindle cell carcinoma • giant cell carcinoma • carcinosarcoma • pulmonary blastoma

  42. pulmonary blastoma Pleuropulmonary blastoma blastoma Monofazik pulmonary blastoma: Fetal adenocarcinoma: İyi diferansiye fetal adenocarcinoma

  43. Force&Patterson, 2003

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