Inomata Minehiko, Kawagishi Yukio, Yamada Toru, Miwa Toshiro, Hayashi Ryuji, Kashii Tatsuhiko, Matsui Shoko, Fukuoka Junya, Tobe Kazuyuki
First Department of Internal Medicine, University of Toyama.
Nihon Kokyuki Gakkai Zasshi. 2010 Jan;48(1):33-8.
We report 2 cases of pulmonary sarcomatoid carcinoma mimicking malignant mesothelioma. Case 1: A 69 year-old man presented, complaining of right chest pain. The chest X ray film and CT showed tumors in the right chest wall and pleura. Histological findings of specimens obtained from a percutaneous biopsy revealed spindle tumor cells, and the immunohistochemistry showed that the tumor cells were positive for CK-7, AE1/AE3, and vimentin and negative for calretinin, D2-40, and WT-1. We diagnosed pulmonary sarcomatoid carcinoma and started chemotherapy with carboplatin and paclitaxel, but it was ineffective. Case 2: A 68 year-old man was admitted complaining of general malaise. The chest X ray film and CT revealed tumors in the right chest wall. Histological findings showed necrosis and spindle tumor cells which were positive for AE1/AE3 and vimentin, and negative for calretinin, D2-40, and WT-1. We diagnosed pulmonary sarcomatoid carcinoma and started chemotherapy with carboplatin and paclitaxel. However the disease continued to progress and he died 2 months after admission. The pulmonary sarcomatoid carcinoma was reported to have spred to the pleural and chest wall. The present two cases showed prominent chest wall and pleural tumors with obscure primary lung tumors. Therefore, we needed to differentiate sarcomatoid carcinoma from malignant pleural mesothelioma.
我们报告2例酷似恶性间皮瘤的肺肉瘤样癌。病例1：一名69岁男性就诊，主诉右胸痛。胸部X线片和CT显示右胸壁和胸膜有肿瘤。经皮活检标本的组织学检查发现梭形肿瘤细胞，免疫组化显示肿瘤细胞CK-7、AE1/AE3和波形蛋白呈阳性，钙视网膜蛋白、D2-40和WT-1呈阴性。我们诊断为肺肉瘤样癌，并开始用卡铂和紫杉醇进行化疗，但无效。病例2：一名68岁男性因全身不适入院。胸部X线片和CT显示右胸壁有肿瘤。组织学检查显示坏死和梭形肿瘤细胞，AE1/AE3和波形蛋白呈阳性，钙视网膜蛋白、D2-40和WT-1呈阴性。我们诊断为肺肉瘤样癌，并开始用卡铂和紫杉醇进行化疗。然而，病情持续进展，患者入院2个月后死亡。据报道，肺肉瘤样癌已扩散至胸膜和胸壁。目前这2例显示胸壁和胸膜有明显肿瘤，而原发肺肿瘤不明显。因此，我们需要将肉瘤样癌与恶性胸膜间皮瘤相鉴别。
