Alhusari Leena, Tahboub Ihab, Masoudi Moh'd, Lawrence Logan M, Jamil Muhammad
Internal Medicine Residency Program, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2023 Dec 30;15(12):e51361. doi: 10.7759/cureus.51361. eCollection 2023 Dec.
Pulmonary sarcomatous carcinoma is a rare subtype of non-small cell lung cancer (NSCLC). This cancer has very low survival rates primarily due to its aggressive nature and propensity for early spread to abdominal organs and the skeletal system. Remarkably, brain metastasis is observed at later stages of the disease, likely attributing to the high fatality rate after the disease progresses to the brain tissue. In our case, a 79-year-old female with a 45-pack-year smoking history sought medical attention at a primary care clinic due to a 3-month history of recurrent right-sided chest pain. Notably, she denied cough, sputum production, palpitations, or syncope. CT chest revealed a 6.8 x 3.5 cm mass in the right upper lobe (RUL) of the lung, with evidence of obstruction and infiltration of the adjacent chest wall. A PET scan indicated increased uptake in the mass and the presence of smaller pulmonary nodules in both lungs, and multiple nodules in the upper left arm, abdomen, right inguinal region, left thigh, and cecum. Importantly, no intracranial lesions were detected. A subsequent colonoscopy yielded normal findings. Histopathologic examination of the lung mass and cell markers was consistent with a diagnosis of sarcomatous carcinoma of the lung. Only three days after the initial clinic visit, the patient presented with numbness and tingling in her lower extremities. Brain MRI revealed multiple bilateral brain metastases accompanied by significant vasogenic edema, prompting treatment with steroid therapy and brain radiation therapy. Subsequent chemotherapy/immunotherapy with Nab-paclitaxel /carboplatin/atezolizumab was initiated but led to significant treatment-related toxicities. Consequently, the treatment plan was adjusted to a single dose of single-agent immunotherapy using pembrolizumab. Unfortunately, the patient chose to discontinue treatment and eventually passed away after 13 days of palliative care. Compared to other lung cancer subtypes, brain metastasis in sarcomatous lung cancer is infrequent due to its lower prevalence among all lung cancer cases. Furthermore, sarcomatous lung cancer has a reduced propensity for developing brain metastasis when compared to other forms of non-small cell lung cancer (NSCLC). Regrettably, the prognosis for sarcomatous lung cancer with brain metastasis remains generally unfavorable, signaling an advanced stage of the disease with limited treatment options.
肺肉瘤样癌是一种罕见的非小细胞肺癌（NSCLC）亚型。这种癌症的生存率极低，主要是因为其侵袭性强，且易于早期扩散至腹部器官和骨骼系统。值得注意的是，脑转移在疾病晚期才会出现，这可能是导致疾病进展至脑组织后死亡率高的原因。在我们的病例中，一名有45年吸烟史的79岁女性因右侧胸痛反复发作3个月，前往初级保健诊所就医。值得注意的是，她否认有咳嗽、咳痰、心悸或晕厥症状。胸部CT显示右肺上叶（RUL）有一个6.8×3.5厘米的肿块，有阻塞及邻近胸壁浸润的迹象。PET扫描显示肿块摄取增加，双肺有较小的肺结节，左上臂、腹部、右腹股沟区、左大腿和盲肠有多个结节。重要的是，未检测到颅内病变。随后的结肠镜检查结果正常。对肺部肿块的组织病理学检查和细胞标志物检查结果与肺肉瘤样癌的诊断一致。在初次就诊仅三天后，患者出现下肢麻木和刺痛。脑部MRI显示双侧多发脑转移，并伴有明显的血管源性水肿，遂开始使用类固醇疗法和脑部放射治疗。随后开始使用纳武单抗/卡铂/阿特珠单抗进行化疗/免疫治疗，但导致了严重的治疗相关毒性反应。因此，治疗方案调整为使用派姆单抗单剂量单药免疫治疗。不幸的是，患者选择停止治疗，最终在接受13天姑息治疗后去世。与其他肺癌亚型相比，肉瘤样肺癌的脑转移并不常见，因为其在所有肺癌病例中的发病率较低。此外，与其他形式的非小细胞肺癌（NSCLC）相比，肉瘤样肺癌发生脑转移的倾向较低。遗憾的是，伴有脑转移的肉瘤样肺癌的预后通常仍然不佳，这表明疾病已处于晚期，治疗选择有限。
