Case Report
Carcinosarcoma: A Rare Lung Tumor
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Report of Three Cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "110" "paginaFinal" => "112" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2927 "Ancho" => 2340 "Tamanyo" => 1493798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Extensive bilateral bronchiectasis and bronchioloectasis, tarnished glass, septal thickening and. (B) Lung parenchyma with abundant dilated bronchial structures with mucoid material (yellow arrow). (C and D) Intraluminal mucoid material shows intraluminal polymorphonuclear intraluminal polymorphs (blue arrow), and bronchiolar structures are surrounded by a notable lymphocytic inflammatory infiltrate (red arrow). (E) Hiliomediastinal adenopathies (up to 18<span class="elsevierStyleHsp" style=""></span>mm, previously 15<span class="elsevierStyleHsp" style=""></span>mm), bronchiectasis, nodular lesions and ground glass. (F) Bronchial structures surrounded by lymphocytic infiltrate (yellow arrow), mucoid material with presence of neutrophils (blue arrow). (G) Reticulonodular pattern with predominant distribution in bases, paratracheal (12<span class="elsevierStyleHsp" style=""></span>mm) and subcarinal (10<span class="elsevierStyleHsp" style=""></span>mm) adenopathy. (H) Peribronchial lymphocytic infiltrate.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Stephany Ivonne Briones Alvarado, Katiuska Herminia Liendo Martínez, Huáscar Galindo Guzman, Francisco Caballero Segura, Fernando Pedraza" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Stephany Ivonne" "apellidos" => "Briones Alvarado" ] 1 => array:2 [ "nombre" => "Katiuska Herminia" "apellidos" => "Liendo Martínez" ] 2 => array:2 [ "nombre" => "Huáscar" "apellidos" => "Galindo Guzman" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "Caballero Segura" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Pedraza" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004040?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004040/v3_202406051408/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S030028962300371X" "issn" => "03002896" "doi" => 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] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana María Andrés Blanco, Milko Terranova Ríos, Alvaro Pérez Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ana María" "apellidos" => "Andrés Blanco" "email" => array:1 [ 0 => "ana_andres_blanco@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Milko" "apellidos" => "Terranova Ríos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alvaro" "apellidos" => "Pérez Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pneumology Department, Hospital Río Hortega, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pathological Anatomy Department, Hospital Clínico, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 903 "Ancho" => 900 "Tamanyo" => 142382 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT, endobronquial tumor, TBNA performed with endobronchial ultrasound (EBUS) and histological image.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Carcinosarcomas are rare lung tumors belonging to the group of sarcomatoid carcinomas. They are a very rare histological type of lung tumor, representing less than 1% of all lung cancers and the definitive diagnosis is obtained, in many cases, by studying the resection piece.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">These tumors contain a mixture of malignant elements: epithelial (epidermoid or adenocarcinoma) and sarcomatous (rhabdomyosarcoma, osteosarcoma and chondrosarcoma).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Preoperative diagnosis is difficult because the histological samples are too small or necrotic to show both components and patients often have an erroneous diagnosis prior to surgery, as was the case with our patient.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our case is a 75-year-old man, a former smoker who quit 10 years ago, came to the emergency room for a cough with purulent sputum without fever. A chest scan was performed where pulmonary consolidation with a patchy distribution was detected in LSD, LM, LID and LII, and bilateral pneumonia was diagnosed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A). The patient was admitted to the ward for control and treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In subsequent controls, there was little radiological improvement, so a bronchoscopy was performed to take samples. An endobronchial mass in the intermediate bronchus was discovered. A biopsy of the lesion resulted in necrotic material (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0030" class="elsevierStylePara elsevierViewall">An endobronchial ultrasound (EBUS) was then performed for lymph node staging, with a negative (N0) result with a new biopsy where, once again, the material was necrotic but the bronchialaspiration was positive for squamous cell carcinoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0035" class="elsevierStylePara elsevierViewall">A cryobiopsy of the lesion was performed due to the absence of sufficient histological material and a tumor with an angiocentric growth pattern was identified, composed of pleomorphic cells growing on a lax stroma. Part of the tumor cellularity exhibit an enlarged nucleus of ovoid morphology with central nucleolus and clear eosinophilic cytoplasms. Other fields show a fusiform cellularity with clear cytoplasms that are arranged on a desmoplastic stroma. Histological and immunophenotypic findings compatible with carcinosarcoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, pulmonary carcinosarcomas constitute a very rare histological type of tumor, difficult to diagnose anatomopathologically before surgery, requiring large samples to reach a correct diagnosis. Cryobiopsy is an easy and safe tool that allows us to obtain larger tissue samples in better condition for an anatomopathological study as tissue alterations are avoided because the sample is frozen before extraction. Likewise, it can be performed on an outpatient basis, with the patient requiring just a few hours of monitoring if there are no complications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 903 "Ancho" => 900 "Tamanyo" => 142382 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT, endobronquial tumor, TBNA performed with endobronchial ultrasound (EBUS) and histological image.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization. Fact sheets: cancer. <a target="_blank" href="http://www.who.int/news-room/fact-sheets/detail/cancer">http://www.who.int/news-room/fact-sheets/detail/cancer</a> [accessed 18.6.18]." ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic tumours" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "WHO Classification of tumours Editorial Board" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "5th ed." "fecha" => "2021" "editorial" => "IARC Publications" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of sarcomatoid carcinoma of the lung: a surveillance, epidemiology, and end results database analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Yendamuri" 1 => "L. Caty" 2 => "M. Pine" 3 => "S. Adem" 4 => "P. Bogner" 5 => "A. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.surg.2012.05.007" "Revista" => array:5 [ "tituloSerie" => "Surgery" "fecha" => "2012" "volumen" => "152" "paginaInicial" => "397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22739072" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack749496" "titulo" => "Acknowledgements" "texto" => "<p id="par0045" class="elsevierStylePara elsevierViewall">The authors thank Kimberly Fitler and Carlos Disdier for her advice during the preparation of this paper.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004015/v3_202406051408/en/main.assets" "Apartado" => array:4 [ "identificador" => "93562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000002/v3_202406051408/S0300289623004015/v3_202406051408/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004015?idApp=UINPBA00003Z" ]
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