Malignant mixed epithelial/mesenchymal neoplasms of the lung.
Semin Diagn Pathol. 1995 May;12(2):123-39.
The existence of biphasic
neoplasms occurring primarily in the lung is a well-known albeit rare
event. The spectrum of malignant tumors displaying a mixed epithelial/mesenchymal
growth pattern is rather narrow when these tumors occur primarily in
the lung. The two most often encountered neoplasms showing features of
epithelial and mesenchymal differentiation are carcinosarcomas and
pulmonary blastomas. Tumors with analogous features are of ubiquitous
distribution in the human body and have been described in numerous
other organs, including the gastrointestinal tract, the genitourinary
tract, and the endocrine system. Although the histopathologic features
of these tumors may seem simple in most cases, there appear to be
numerous pitfalls in their diagnosis; gray areas still remain in the
characterization of these tumors, because a certain degree of overlap
may be encountered with these two conditions. Such problems are
understandable because the incidence of these tumors in the general
population is very rare. Therefore, one is expected to find divergent
points of view regarding these neoplasms. It is of importance,
however, to unify criteria not only for diagnostic purposes, but also
to determine the prevalence and behavior of these neoplasms, because
such information may provide a rationale for adjustment and
improvement in the treatment and diagnosis of these unusual neoplasms.
We will review past and current concepts regarding these unusual
tumors, as well as their more salient histopathologic features.
The clinical analysis and review of literature
of pulmonary carcinosarcoma and blastoma.Zhonghua
Jie He He Hu Xi Za Zhi. 1999
Sep;22(9):541-4
OBJECTIVE: To explore the clinical characteristics, diagnosis,
treatment of pulmonary carcinosarcoma and blastoma. METHODS:
Summarizing retrospectively 15 cases of pulmonary carcinosarcoma and 2
cases of pulmonary blastoma from January 1979 to November 1998, and
reviewing literature to analyse their histologic, clinical feature,
diagnosis and treatment. RESULTS: Pulmonary carcinosarcoma and
blastoma both were found to be rare malignant tumors, and both
epithelial and mesenchymal elements can be seen under the microscopy
with different characteristic features. It was hard to be diagnosed
before operation. The main symptoms of pulmonary carcinosarcoma were
cough, expectoration, sometimes bloody phlegm. X-ray showed that
peripheral type were most common, and 2-5 cm in size, well-distributed
in density, some showed central or eccentric cavities whose wall was
irregular. The margin of the focuses were clear, leafy, the distensive
lymph nodes of hilum or mediastium could also be seen. Bronchoscopic
examination revealed the bronchial cavity was obstructed by mass or
became stricted. Local biopsy can found squamous, adenocarcinoma or
large cell carcinoma, respectively. Malignant cell can also be found
in sputum. So it was easy to be confused with lung cancer. 14 cases of
the carcinosarcoma were treated surgically and diagnosed, 1 case was
diagnosed by lymph node biopsy. The symptoms of pulmonary blastoma
were fever and hemoptysis. X-ray or CT scan showed an isolated mass in
the lung, with uneven density. Malignant cells in pleural effusion
were found in one case and can not be diagnosed definetely but by
pulmonary puncture. The another case was diagnosed by surgical
operation. 15 cases of this group were followed up, in which 4 cases
are still alive (including 1 case of pulmonary blastoma), the 1-year
survival of carcinosarcoma is 30% (3/10), 2-year survival 20% (2/10),
in which 1 case survived more than 6 years. Another pulmonary blastoma
case only survived 3 months. CONCLUSIONS: These 2 kinds of malignant
tumor are often easy to be misdiagnosed, and prognosis is very poor.
Surgical resection is the main method of diagnosis and treatment.
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