Pulmonary tumor diagnosed as an undifferentiated sarcoma with epithelioid features: a case report

Our plain-English summary of Pulmonary tumor diagnosed as an undifferentiated sarcoma with epithelioid features: a case report, by M.R. El Ochi, M.M. El Hammoumi, A. Biyi, et al (Journal of Medical Case Reports, 2016).

The study

• Authors: M.R. El Ochi, M.M. El Hammoumi, A. Biyi, M. Allaoui, E.H. Kabiri, A. Albouzidi, M. Oukabli
• Journal: Journal of Medical Case Reports
• Published: 2016;10(1):274
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pulmonary sarcomas are uncommon accounting for 0.5 % of all primary lung cancers. Undifferentiated sarcomas account for up to 20 % of soft tissue sarcomas. A lung tumor revealed to be an undifferentiated sarcoma with epithelioid features has never been reported in the literature.

Case Presentation: A 61-year-old white Moroccan man presented with 2 months' history of hemoptysis and dyspnea. Chest computed tomography showed a cystic mass involving the lower field of his right lung evoking first a hydatid cyst. Abdominal computed tomography revealed bilateral adrenal nodules. Surgical resection of the lung mass was performed. On pathological examination, the tumor was cystic containing necrotic material. A histological diagnosis of undifferentiated sarcoma with epithelioid features was made. A positron emission tomography scan showed involvement of his pleura, left colon, adrenal glands, left thigh muscle, and leptomeninges.

Conclusions: Undifferentiated sarcoma with epithelioid features is a rare malignant mesenchymal tumor. Clinical and radiological features are not specific. A differential diagnosis includes sarcomatoid carcinoma, malignant mesothelioma, melanoma, and other epithelioid sarcomas.

In plain English

This case report described a 61-year-old white Moroccan man with no significant past medical history. He came to Mohamed V Military Hospital after two months of coughing up blood and shortness of breath. A chest CT scan showed a 5×4.8 cm cystic mass in the lower part of his right lung, which first suggested a hydatid cyst. An abdominal CT showed nodules on both adrenal glands. The lung mass was removed by surgery. It contained dead (necrotic) material and was made of epithelioid cells with many dividing cells. From these features and a panel of stains, the authors diagnosed a grade III undifferentiated sarcoma with epithelioid features, which they described as the first such case reported in the lung. The surgical margins contained tumor. A PET scan 28 days after surgery showed activity in the lung tumor, left colon, adrenal glands, left thigh muscle and the membranes around the brain. A colonoscopy was normal. The man was receiving chemotherapy. The authors listed malignant mesothelioma among the tumors that must be ruled out. The article does not mention asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 61-year-old white Moroccan man with no significant past medical history, seen at Mohamed V Military Hospital (Rabat, Morocco) with hemoptysis and dyspnea that began 2 months before admission
• Main results:
  • Chest CT showed a cystic mass in the lower field of the right lung measuring 5×4.8 cm, without mediastinal adenopathy, first suggesting a hydatid cyst.
  • Abdominal CT showed bilateral adrenal nodules compatible with nodular hyperplasia, measuring 5.3×4.1 cm on the right and 3×2.6 cm on the left.
  • The removed tumor was cystic with necrotic material. It consisted of nests and sheets of epithelioid cells with numerous mitoses (27 mitoses per 10 high-power fields).
  • Tumor cells were diffusely positive for vimentin and smooth muscle actin and focally positive for CD99. Many other markers were negative, including cytokeratins, calretinin, WT1, D2-40 and CK5/6.
  • The diagnosis was undifferentiated sarcoma with epithelioid features, FNCLCC grade III. The surgical margins were positive.
  • A PET scan on the 28th day after surgery showed increased FDG uptake in the lung tumor, left colon, adrenal glands, left thigh muscle and leptomeninges. A colonoscopy was normal, and the patient was undergoing anti-mitotic chemotherapy.
• The authors' conclusion: The authors concluded that undifferentiated sarcomas with epithelioid features are extremely rare, and that diagnosis relies on morphological and immunohistochemical analyses to exclude other diagnoses. They listed sarcomatoid carcinoma, malignant mesothelioma, melanoma and other sarcomas as those other diagnoses.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Sarcoma, Epithelioid, Lung Cancer, Hemoptysis, Dyspnea, Bilateral, Surgical Resection, Pleura.

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• Epithelioid sarcoma. A clinical and pathologic study of nine cases — H. Santiago, L.K. Feinerman, et al. (1972)
• Metastatic proximal epithelioid sarcoma in pleural effusion: cytopathologic findings and differential diagnosis — H. Guan, F. Haque, et al. (2013)
• A Case of Primary Epithelioid Sarcoma of the Pleura — T. Yamashita (2023)

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