2024 Volume 38 Issue 2 Pages 119-124
The blastomatoid variant of pulmonary carcinosarcoma is a rare variant among carcinosarcomas, with only a few cases reported. Here, we describe the case of a 72-year-old man diagnosed with the blastomatoid variant of pulmonary carcinosarcoma. The patient had undergone surgery for hepatocellular carcinoma, and computed tomography (CT) performed during follow-up for postoperative recurrence of hepatocellular carcinoma and postoperative bronchobiliary fistula formation revealed a 28-mm nodule in the lower lobe of the right lung. CT-guided biopsy led to a suspected diagnosis of pleomorphic carcinoma or carcinosarcoma, and surgery was performed for the primary lung cancer. Intraoperative examination revealed that the right lower lobe and diaphragm were tightly adherent to each other due to the bronchobiliary fistula formation, and partial resection of lung was performed. Postoperative histopathology revealed the lung tumor to be a pulmonary blastomatoid carcinosarcoma with a rhabdomyosarcoma component and an epithelial component of H-FLAC (high-grade fetal lung adenocarcinoma). Nine months after pulmonary resection, local recurrence was diagnosed, and the patient received radiotherapy. Thereafter, while the tumor did not increase in size, the general condition of the patient deteriorated rapidly due to progression of the hepatocellular carcinoma, and the patient died 16 months after pulmonary surgery. The prognosis of patients with blastomatoid carcinosarcoma is poor, and there are no established treatments other than complete resection. Since the reported number of cases of pulmonary blastomatoid carcinosarcoma is small, it would be desirable to develop and establish treatment for patients with lung carcinosarcoma.
