Yu Xiuwen, Huang Mingqi, Ge Haiyan, Yang Junjie, Huang Bin, Xu Jialing
Department of Respiratory Medicine, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China.
Department of Traditional Chinese Medicine, Faculty of Chinese Medicine Science Guangxi University of Chinese Medicine, Nanning, China.
Medicine (Baltimore). 2024 Dec 13;103(50):e40766. doi: 10.1097/MD.0000000000040766.
Primary sarcomatoid carcinoma of the trachea (PSCT) is a rare malignant tumor of the lower respiratory tract. Pathological types of tracheal sarcomatoid carcinoma (TSC)s include pleomorphic carcinomas, giant cell carcinomas, spindle cell carcinomas, pulmonoblastomas, and carcinosarcomas. At present, there are limited reports on PSCT, and pathologists lack sufficient knowledge about it.
Here, we report a case of malignant neoplasm involving the left posterior wall of the initial tracheal segment, characterized by atypical spindle cells and a small number of high-grade squamous intraepithelial neoplasia.
Spindle-shaped cells were moderately heterotypic, with 8/10 nuclear divisions (high-magnification field), and no obvious inflammatory cell infiltration was observed in the interstitium. Squamous epithelial cells showed moderate-to-severe atypia with regional cytoplasmic transparency. Immunohistochemistry: Fusiform tumor cells expressed vimentin, epithelial markers were negative, the Ki-67 proliferation index was 40%, and epithelial markers were expressed in squamous intraepithelial neoplasia.
After the biopsy diagnosis was confirmed, part of the tumor was removed by tracheoscopy under general anesthesia in the respiratory department of a superior hospital. A pathological diagnosis of TSC was made and local radiotherapy was performed.
As the tumor could not be completely cured, the patient experienced repeated coughing and shortness of breath and died of the disease 15 months later.
Pathological morphology and immunohistochemical analyses deepen our understanding of the pathological features of TSC and provide a diagnostic reference for clinicians who will encounter such cases in the future.
气管原发性肉瘤样癌（PSCT）是下呼吸道的一种罕见恶性肿瘤。气管肉瘤样癌（TSC）的病理类型包括多形性癌、巨细胞癌、梭形细胞癌、肺母细胞瘤和癌肉瘤。目前，关于PSCT的报道有限，病理学家对其了解不足。
在此，我们报告一例累及气管起始段左后壁的恶性肿瘤病例，其特征为非典型梭形细胞和少量高级别鳞状上皮内瘤变。
梭形细胞具有中度异型性，在高倍视野下有8/10个核分裂象，间质未见明显炎性细胞浸润。鳞状上皮细胞显示中度至重度异型性，局部细胞质透明。免疫组化：梭形肿瘤细胞表达波形蛋白，上皮标志物阴性，Ki-67增殖指数为40%，鳞状上皮内瘤变中表达上皮标志物。
活检诊断明确后，上级医院呼吸科在全身麻醉下通过气管镜切除部分肿瘤。病理诊断为TSC并进行了局部放疗。
由于肿瘤无法完全治愈，患者反复咳嗽、气短，15个月后死于该病。
病理形态学和免疫组化分析加深了我们对TSC病理特征的理解，为未来遇到此类病例的临床医生提供了诊断参考。
