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Primary sarcomas of
the lung.
Semin Diagn Pathol. 1995 May;12(2):140-57.
Primary
pulmonary sarcomas are rare tumors. Because the lung is one of the
favored metastatic sites for soft tissue sarcomas, care must be taken
when evaluating these lesions to rule out the possibility of an
alternate primary source by means of thorough clinical history and
radiographic evaluation. In addition to the difficulties involved in
separating primary from metastatic tumors, pulmonary sarcomas must be
distinguished from a number of sarcomalike primary lung neoplasms,
including spindle and giant cell (pleomorphic) carcinoma, and from
mixed epithelial/mesenchymal lesions such as pulmonary blastoma and
carcinosarcoma. The criteria helpful for accomplishing this
distinction are discussed, along with a review of primary sarcomas of
the lung, with emphasis on clinicopathologic, immunohistochemical, and
ultrastructural features that may be of aid for diagnosis.
Additionally, recent or newly described entities are also discussed,
and evolving concepts on the pathogenesis and terminology of these
lesions are underscored.
Primary
pulmonary sarcomas: etiology, clinical assessment and prognosis with a
comparison to pulmonary carcinomas--a review of 41 cases and 394 other
cases of the literature.
Jpn J
Surg. 1982;12(2):148-59
Primary
sarcomas of the lungs occur at frequencies of 1:100, as compared with
carcinomas reported in our retrospective studies covering 394 cases
reported in the literature from 1957 to 1972 and 41 cases from 1957 to
1974. The average age was 45 years, the disease usually occurred
between the ages of 35 and 65, the peak being between 45 and 60 years.
Distribution between sexes was much the same as that seen in general.
X-ray with rapid thoracotomy provided the best clinical results. The
literature showed a postoperative survival time of 5 years in 19% and
44% of our own cases. The general metastasis, haematologenous and
lymphogenous were more or less equal and recidive tendency in 7%
essentially varied, as related to the single histological forms.
Lymphosarcomas (28.6%) were the most frequent, the group of
spindle-celled sarcomas, inclusive of leiomyosarcomas, occurred in
40%. Histological maturity of the tissues and the prognosis according
to active therapy were in parallel. A comparison of 41 primary
sarcomas of the lungs with the 192 cases of carcinomas seen in our
clinic showed no connection between sarcomas of the lungs and smoking
of cigarettes, pollution of the environment, industrial toxins or
chronic bronchitis. These findings relate to the peripheral
localization as well as to the lack of incidence among men, with
regard to pulmonary adenocarcinomas. An overall view of the
characteristics led to the assumption of a probable endogenous tumour.
A summarization of the characteristics of pulmonary sarcomas and
carcinomas revealed the role of primary sarcomas in the total complex
of malignant tumours of the lungs.
Primary
sarcomas of the lung: a clinicopathologic study of 12 cases.
Lung Cancer. 2002 Dec;38(3):283-9
BACKGROUND:
Chest physicians have a limited experience of primary pulmonary
sarcomas, which represent a particular entity among rare intrathoracic
neoplasms. DESIGN: Retrospective review of medical records. PURPOSE:
To study patients with primary sarcomas of the lung diagnosed in our
pathology department in order to define their clinical
characteristics, treatment, and prognosis. PATIENTS: The study group
consisted of 12 patients, with a mean age of 53 years. RESULTS: The
main symptoms were chest pain, and cough. Imaging findings consisted
of: eight single peripheral opacities, three single parahilar
opacities, and one lobar actelectasis. The histologic diagnoses
confirmed in all cases by detailed immunohistochemical study were
leiomyosarcoma (7), monophasic synovial sarcoma (2), one case each of
malignant peripheral nerve sheath tumor (MPNST), epithelioid sarcoma,
and malignant fibrous histiocytoma. Thoracic surgery done in nine
cases consisted of six lobectomies with further parietal resection in
two cases, and three pneumonectomies. Four patients received
chemotherapy and two patients had radiation therapy postoperatively.
Follow up available on 12 patients ranged from 3 to 144 (mean 42)
months. Long term survival up to 3 years was observed in five
patients. Median overall survival was 48 months. Overall 5-year
survival rate was 38%. CONCLUSIONS: Primary sarcomas of the lung are a
rare and aggressive malignancy. Treatment and prognosis do not differ
from other soft tissue sarcomas.
Transthoracic
fine-needle aspiration biopsy of pulmonary spindle cell and
mesenchymal lesions: a study of 61 cases.Cancer.
2001 Jun 25;93(3):187-98
BACKGROUND:
Spindle cell and mesenchymal lesions of the lung encompass a wide
variety of benign and malignant conditions. However, to the authors'
knowledge, because of their rarity, few reports concerning their
cytologic findings are available in the literature. The current review
emphasizes the cytomorphologic features, differential diagnosis, and
potential pitfalls associated with these lesions. METHODS: Seven
hundred seventy-nine percutaneous lung fine-needle aspiration (FNA)
specimens were retrieved from the authors' cytopathology files over a
period of 5 years. Sixty-one cases (7.8%) in which a spindle cell
component was the dominant or key feature were identified. The authors
reviewed the cytologic smears, immunocytochemical studies, and
corresponding surgical material and clinical information. RESULTS: Of
these 61 aspirates, 33 (54%) were reactive processes (31 granulomas, 1
organizing pneumonia, and 1 inflammatory pseudotumor). Five cases
(0.8%) were benign neoplasms (2 hamartomas, 2 solitary fibrous tumors,
and 1 schwannoma). Twenty-three cases (38%) were malignant neoplasms
(8 cases were primary tumors [including 5 carcinomas with spindle cell
or sarcomatoid features, 1 spindle cell carcinoid tumor, 1
leiomyosarcoma, and 1 synovial sarcoma] and 15 cases were secondary
tumors [including 9 melanomas, 2 leiomyosarcomas, 1 malignant fibrous
histiocytoma, 1 meningioma, 1 sarcomatoid renal cell carcinoma, and 1
uterine malignant mixed mullerian tumor]). A specific diagnosis was
rendered in 52 cases (85%). No false-positive cases were encountered
but there was one false-negative case. One patient who was diagnosed
with granulomatous inflammation on FNA was found to have nonsmall cell
lung carcinoma on subsequent transbronchial biopsy. No malignant cells
were identified in the smears on review. The FNA from the organizing
pneumonia was interpreted as a solitary fibrous tumor whereas the
inflammatory pseudotumor was diagnosed as granulomatous inflammation.
The FNA from one pulmonary hamartoma initially was considered to be
nondiagnostic. One solitary fibrous tumor and the schwannoma were
diagnosed as smooth muscle tumor and spindle cell tumor, not otherwise
specified, respectively. Among the malignant tumors, the primary
synovial sarcoma and one of the metastatic malignant melanomas
initially were interpreted as primitive neuroectodermal tumor/Ewing
sarcoma and poorly differentiated carcinoma, respectively.
CONCLUSIONS: Spindle cell lesions of the lung rarely are encountered
on transthoracic lung FNA and are comprised of a wide variety of
benign and malignant entities. By correlating clinical and radiologic
data, cytologic findings, and ancillary studies, a high diagnostic
accuracy rate can be achieved with FNA.
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