Pulmonary carcinosarcoma: diagnostic problems and determinants of the prognosis

Abstract

OBJECTIVE: Bronchopulmonary carcinosarcoma is a very rare tumor and theprognosis of patients with carcinosarcoma is assessed as unfavourable. Theproblems concerning diagnosis, therapy, and prognosis after resectiontreatment are discussed with reference to our seven cases and withconsideration of the pertinent literature. METHODS: The retrospective dataof seven patients with pulmonary carcinosarcoma were analysed. All werestaged postoperatively according to the international TNM staging system.The diagnosis was verified by immunohistochemical investigation. Theprognosis of the patients with carcinosarcoma was compared with theprognosis of patients with non- small cell carcinoma of the lung. RESULTS:Whether lung resection is the treatment of choice for these patients is ofno relevance, because in most cases the preoperative diagnosis isincomplete, as only one component of the tumor, namely the epithelial one,is found in the biopsy specimen. The complete and correct diagnosis in fiveof the seven cases was not made before the resection had been performed andin the remaining two patients it was only made when tumor recurrence ormetastases occurred. The prognosis of patients with carcinosarcoma of thelung is assessed to be comparable to that of patients with other pulmonarycarcinoma: in this study survival times ranged from only 3 months (T2N3) to4 years 6 months (T3N1). The causes of death of the patients withcarcinosarcoma were local recurrence in four patients and metastases atdistant sites in two. Two recurrent tumors as well as the metastasesconsisted only of the sarcoma component of the primary tumorhistologically. CONCLUSION: One may suggest that the prognosis ofcarcinosarcoma might be determined by the sarcoma component of the tumor.Therefore the generally accepted therapies of soft tissue sarcomas shouldbe adopted for the follow-up treatment of patients with pulmonarycarcinosarcoma.