Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare subtype of non-small cell lung carcinoma (NSCLC) commonly seen in elderly smoker males with non-specific clinical features. The confirmed diagnosis is done if tumor contains both sarcomatoid and epithelial components with at least 10% of the tumor and usually requires IHC confirmation. The preoperative diagnosis is very difficult due to the rarity of the disease and histological over/under presentation. Pleural involvement with effusion is not a common presenting feature of PSC. The tumor is usually locally advanced with a poor prognosis and had poor survival rate. We report a unique and rare case of PSC in a middle-aged, non-smoker lady with massive pleural effusion. She presented with sudden onset massive effusion. The computed tomography (CT) chest showed massive effusion with multiple pleural nodules and thickening. The diagnosis was confirmed by histopathology and immune histochemical (IHC) staining of thoracoscopic pleural biopsy.
Detterbeck FC, Boffa DJ, Kim AW, et al. Eighth edition lung cancer stage classification. Chest 2017;151(1):193–203. DOI: 10.1016/j.chest.2016.10.010.
Balamugesh T. Are the day of closedpleural biopsy over? No. Lung India 2015;32(6):641–643. DOI: 10.4103/0970-2113.168140.
Dixit R, Agarwal KC, Gokhroo A, et al. Diagnosis and management options in malignant pleural effusions. Lung India 2017;34(2):160–166. DOI: 10.4103/0970-2113.201305.
Sugiura S, Ando Y, Minami H, et al. Prognostic value of pleural effusion in patients with non-small cell lung cancer. Clin Cancer Res 1997;3(1):47–50. PMID: 9815536.
Saha K, Maikap MK, Maji A, et al. Demographic, clinical, biochemical, radiological andetiological characteristics of malignant pleural effusions from Eastern India. Indian J Cancer 2017;54(1):257–261. DOI: 10.4103/0019-509X.219575.
Spalgais S, Pal RS, Gothi D et al. The role of closed pleural biopsy in the era of thoracoscopy International Journal of current Medical and Applied sciences 2016;10(3):129–132. Available from: www.ijcmaas.com.
Lee P, Colt HG. Pleuroscopy in 2013. Clin Chest Med 2013;34(1):81–91. DOI: 10.1016/j.ccm.2012.11.003.
Branscheid D, Krysa S, Bauer E, et al. Diagnostic and therapeutic strategy in malignant pleural mesothelioma. Br J Cardiothorac Surg 1991;5(9):466–472. DOI: 10.1016/1010-7940(91)90142-7.
Metintas M, Ucgun I, Elbek O, et al. Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. Eur J Radio 2002;41(1):1–9. DOI: 10.1016/s0720-048x(01)00426-0.
Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis 2015;32:87–93. DOI: 10.1016/j.ijid.2014.12.007.
Roesel C, Terjung S, Weinreich G, et al. Sarcomatoid carcinoma of the lung: A rare histological subtype of non-small cell lung cancer with a poor prognosis even at earlier tumour stages. Interact Cardio Vasc Thorac Surg 2017;24(3):407–413. DOI: 10.1093/icvts/ivw392.
Huang SY, Shen SJ, Li XY. Pulmonary sarcomatoid carcinoma: A clinicopathologic study and prognostic analysis of 51 cases. World J Surg Oncol 2013;11:252. DOI: 10.1186/1477-7819-11-252.
Franks TJ, Galvin JR. Sarcomatoid carcinoma of the lung: Histologic criteria and common lesions in the differential diagnosis. Arch Pathol Lab Med 2010;134(1):49–54. DOI: 10.5858/2008-0547-RAR.1.
Karim NA, Schuster J, Eldessouki I, et al. Pulmonary sarcomatoid carcinoma: University of Cincinnati experience. Oncotarget 2018;9(3):4102–4108. DOI: 10.18632/oncotarget.23468.
Beasley MB, Brambilla E, Travis WD. The 2004 World Health Organization classification of lung tumors. Semin Roentgenol 2005;40(2):90–97. DOI: 10.1053/j.ro.2005.01.001.
Travis WD, Brambilla E, Burke AP, et al. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart, 4th edition. IARC. 2015. pp. 88–94.
