Postmortem Investigation of Immunohistochemical Staining and Gross Description of Sarcomatoid Carcinoma of the Lung in a Patient With Extreme Leukemoid Reaction.

A 72-year-old male smoker was brought into the emergency department complaining of 4 months of progressive dyspnea and fatigue. Computed tomography angiogram of the lungs was negative for pulmonary embolism; however, a 10 cm right upper lobe mass and multiple bilateral pulmonary nodules were identified. While computed tomography scan of the head showed no lesions in the brain, there was osseous destruction of the right mandible. Records obtained from an outside hospital indicated that he had 2 prior biopsies of this lung mass that failed to show malignant cells. In addition, an outpatient positron emission tomography scan had shown increased tracer uptake in this mass as well as multiple nodules in the contralateral lung and in the left adrenal gland. This gentleman was admitted for sepsis and was started on broad-spectrum antibiotics. He continued to have respiratory compromise and required transfer to the intensive care unit for intubation and mechanical ventilation. Over the next 4 days, the patient progressed into septic shock requiring vasopressors and developed worsening respiratory failure. His white blood cell count continued to rise and peaked at 157 × 103 cells/µL. The patient's wife decided to proceed with comfort measures and the patient subsequently expired. Autopsy was consistent with sarcomatoid carcinoma, also known as giant cell carcinoma of the lung. Immunohistochemical staining was also performed, which identified several tumor markers as well as distant metastasis, hemorrhage, and multi-organ necrosis.

Sarcomatoid carcinoma of the lung: a clinicopathologic study of 37 cases.

BACKGROUND: Spindle and giant cell carcinomas of the lung are rare subtypes and are regarded as one type of lung carcinoma, termed pleomorphic carcinoma in the Armed Forces Institute of Pathology classification. This classification is different from the World Health Organization classification. METHODS: Thirty-seven cases of sarcomatoid (spindle and/or giant cell) carcinoma of the lung were studied by light microscopy, conventional histochemistry, and immunohistochemistry to establish their clinical and histologic characteristics. RESULTS: The patient population was comprised of 29 men and 8 women ages 33-81 years. Seventeen patients died of their disease and there was no statistically significant difference in patient prognosis between sarcomatoid carcinoma and nonsarcomatoid carcinoma of the lung. Using light microscopy, 5 cases (13.5%) comprised entirely of sarcomatoid components without carcinomatous elements were classified as Group A. In the remaining 32 cases (86. 5%), classified as Group B, carcinomatous components were present (adenocarcinoma [18 cases; 48.7%], squamous cell carcinoma [8 cases; 21.6%], and large cell carcinoma [6 cases; 16.2%]). Sarcomatoid components were divided further into three categories: spindle cell type, giant cell type, and mixed spindle and giant cell type. Immunohistochemically, the sarcomatoid components of all 37 cases were positive for cytokeratins. Statistically, there was no significant prognostic difference between the 37 cases of sarcomatoid carcinoma and 647 cases of nonsarcomatoid, nonsmall cell carcinoma of the lung (P = 0.8537). CONCLUSIONS: The sarcomatoid portions in all sarcomatoid carcinomas in the current study showed an epithelial differentiation, and there was no apparent difference in biologic behavior between sarcomatoid carcinoma and ordinary lung carcinoma.

[Problems in the classification of thyroid tumors. Their significance for prognosis and therapy]. / Probleme der Klassifizierung von Schilddrüsentumoren. Ihre Bedeutung für Prognose und Therapie.

Standardized nomenclatures of tumors are mandatory for epidemiological investigations as well as for the correct interpretation of pathological diagnoses by the clinician. Not least thanks to the activity of the World Health Organization (WHO), uniform tumor nomenclatures in worldwide use have been adopted for most organs. This applies also for the thyroid, even in Switzerland, where many pathologists had formerly been convinced that only the special and rather complicated nomenclature of Langhans, adapted by Wegelin, was consistent with the special tumor situation in Switzerland, a former endemic goiter area. The simplified classification of WHO is demonstrated for the group of malignant tumors of the thyroid and the problems concerning their classification are discussed. Difficulties of classifications arise in well differentiated tumors rather than in undifferentiated, anaplastic forms. For example, it is not possible to assess unequivocally the malignancy of strongly encapsulated forms of highly differentiated follicular tumors. They are then called, rather evasively, "atypical adenomas". The difficulties do not lie in the system of classification but in the tumor's specific manner of growth, and the clinician should be aware of this. Otherwise he may overstrain the diagnostic potentialities of his pathologist.

Hemangioendothelioma of the thyroid gland--true endothelioma or anaplastic carcinoma?

After a critical histological re-examination of 26 cases of malignant hemangioendothelioma of the thyroid, and a comparison with 51 cases of anaplastic spindle and giant cell carcinoma, it becomes obvious that traumatic and shrinkage artefacts due to fixation, as well as superimposition of neoplastic and repair processes due to regressive changes--almost always seen in malignant hemangioendothelioma associated nodular goiter--may be misinterpreted as neoplastic vascular spaces (and therefore angioblastic tumour differentiation). Focal epithelial arrangements of tumour cells often observed in these malignant hemangioendotheliomas and the lack of objective light microscopic differential diagnostic criteria of anaplastic spindle and giant cell carcinoma make the high incidence of endotheliomas of the thyroid in European endemic goiter regions very questionable. Compared with anaplastic spindle and giant cell carcinoma, the incidence for (1) extrathyroid tumours that infiltrate into the trachea or the oesophagus, (2) lymph node metastases and (3) distant metastases is not statistically different in malignant hemangioendothelioma. Therefore we conclude that the tumours classified as malignant hemangioendothelioma in goitrous areas represent a special growth pattern of anaplastic spindle and giant cell carcinoma within adenomatous glands rather than a distinct tumour type.