Cohen-Salmon D, Michel R P, Wang N S, Eddy D, Hanson R
Ann Pathol. 1985;5(2):115-24.
About 50 cases of pulmonary carcinosarcoma have been reported in the French and English literature. They have rarely coexisted with non-pulmonary neoplasms, never with other primary lung tumors. This report describes a 68 year old male smoker with a carcinosarcoma developing in the right upper lobe, one and a half years after a left upper lobectomy for a scar adenocarcinoma. By light microscopy, there was an admixture of adenocarcinomatous, chondrosarcomatous, and malignant spindle cell and giant cell areas. Electron microscopy showed well and poorly differentiated epithelial, smooth muscle and cartilaginous elements. This case is of interest because of its occurrence with another lung primary tumor; the specific diagnosis was made by transthoracic needle aspiration; and of the ultrastructural features. In the literature, carcinosarcomas have been divided into an endobronchial type, in which the carcinomatous component is squamous in 91% of cases, and a peripheral type, in which it is glandular in 50% of cases; the sarcomatous component shows no such correlation with type. The theories for the histogenesis of these tumors revolve around the concept that the carcinoma is the principal element, and the sarcomatous or stromal change secondary. Therefore, on the basis of this case, and of our literature review dealing with the pathology, clinical features and histogenesis of these tumors, we suggest that carcinosarcomas share important features with lung carcinomas.
法语和英语文献中已报道了约50例肺肉瘤样癌。它们很少与非肺部肿瘤共存，从未与其他原发性肺肿瘤共存。本报告描述了一名68岁男性吸烟者，在因瘢痕腺癌行左上叶切除术后一年半，右肺上叶出现肉瘤样癌。光镜下可见腺癌、软骨肉瘤、恶性梭形细胞和巨细胞区域混合存在。电镜显示有分化良好和分化不良的上皮、平滑肌和软骨成分。该病例因其与另一原发性肺肿瘤同时发生、经胸针吸活检做出明确诊断以及具有超微结构特征而备受关注。在文献中，肉瘤样癌分为支气管内型，其中91%的病例癌成分是鳞状的，以及周围型，其中50%的病例癌成分是腺状的；肉瘤成分与类型无此相关性。这些肿瘤的组织发生学理论围绕着癌是主要成分，肉瘤或间质改变是继发的这一概念展开。因此，基于该病例以及我们对这些肿瘤的病理学、临床特征和组织发生学的文献综述，我们认为肉瘤样癌与肺癌有重要的共同特征。
