A case of giant pulmonary carcinosarcoma with the epithelial component of high-grade adenocarcinoma of fetal lung type (H-FLAC)

Abstract

Background. Pulmonary carcinosarcoma is an extremely rare subtype of malignant lung tumors. Preoperative diagnosis is very difficult, and there is no established method of treatment. Case. A 69-year-old man developed exertional dyspnea and visited a local physician. Left pneumothorax and pleural effusion were identified, and pleural drainage was performed. Afterwards, a CT scan revealed a tumor. The man was then transferred to our hospital. The CT showed a large tumor in the left side of the thoracic cavity. An 18-fluorodeoxyglucose positron emission tomography (FDG-PET) scan showed an extremely high SUV. A percutaneous needle biopsy did not obtain a definitive diagnosis. However, because the tumor was growing rapidly, we performed emergency surgery to try to save the man's life. A postoperative pathologic diagnosis identified the disease as pulmonary carcinosarcoma with the epithelial component of high-grade adenocarcinoma of fetal lung type (H-FLAC). The patient was released from the hospital but died 81 days later from residual tumor growth. Conclusion. In Japan, there have been no case reports of this disease in the medical literature. Preoperative diagnosis is very difficult, and immunostaining for beta-catenin is very useful to diagnose H-FLAC. Since the prognosis of this disease is invariably bad, it is essential to develop effective preoperative diagnostic and treatment methods. © 2008 The Japan Lung Cancer Society.