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Vol.52 No.7 contents | Japanese/English |
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- Case Report -
A Case of Solitary Colonic Metastasis from Pulmonary Carcinosarcoma
Nobutaka Kobayashi1, Hiroki Numanami1, Masayuki Yamaji1, Motoya Tanaka1, Emiko Takahashi2, Masayuki Haniuda11Department of Surgery, Division of Chest Surgery, 2Department of Diagnostic Pathology, Aichi Medical University, Japan
Background. Pulmonary carcinosarcoma is a rare malignancy with poor prognosis and is composed of epithelial and sarcomatous tumors. In addition, colonic metastasis from pulmonary carcinosarcoma is extremely rare. Case. A 59-year-old man was admitted to our hospital because of bloody sputum and an abnormal shadow in the chest X-ray. Chest CT showed a 70×45 mm-diameter mass in the left lower lobe. Brain MRI, esophagogastroduodenoscopy and colonoscopy detected no sign of distant metastases. We diagnosed lung cancer (poorly differentiated squamous cell carcinoma) based on bronchoscopic brushing cytology. Left lower lobectomy and lymph node dissection were performed under a diagnosis of primary lung cancer. Histopathological examination revealed moderately differentiated adenocarcinoma surrounded by sarcomatous components such as osteosarcoma and spindle-shaped tumor cells. Seventy percent of the tumor tissue consisted of sarcomatous components, the remaining 30% was adenocarcinoma. The postoperative definitive diagnosis was pulmonary carcinosarcoma (pT2bN0M0, stage IIA). Fifteen months later, he was found to have a semi-pedunculated tumor in the transverse colon on colonoscopy. The tumor was resected by endoscopic mucosal resection (EMR). Microscopic findings of the specimen showed proliferation of vimentin-staining positive, spindle-shaped tumor cells. No carcinomatous element was observed. Based on morphological and immunohistological findings, the tumor was judged to be compatible with colonic metastasis from the pulmonary carcinosarcoma. Subsequently, laparoscopic transverse colectomy was performed because the EMR specimen revealed a positive margin. The patient is alive and well without any evidence of recurrence at 39 months after laparoscopic surgery. Conclusion. We report a surgical case of solitary colonic metastasis from pulmonary carcinosarcoma. To our knowledge, this is the first such case reported in the literature.
key words: Pulmonary carcinosarcoma, Sarcomatoid carcinoma, Solitary metastasis, Colonic metastasis, Semi-pedunculated tumor
Received: July 30, 2012
Accepted: October 10, 2012
JJLC 52 (7): 1017-1022, 2012
