Imaging findings of pulmonary carcinosarcoma: A case report
A 90-years-old male patient came to our hospital with chief complaints of cough with expectoration and breathlessness for one month. There was history of treatment for pulmonary koch's for two years. Personal history revealed that the patient was heavy smoker. Chest radiograph was done and showed a large lobulated right lower lobe opacity silhouetting the right dome of diaphragm. There was blunting of right costo-phrenic angle. Multiple other rounded lobulated opacities were seen in both lung fields. Provisional diagnosis of malignant lung mass with pulmonary metastases was made [].\nComputed tomography (CT) scan of chest was done with intravenous contrast for further evaluation on Siemens Somatom perspective, 128 slice. CT scan showed a large cavitating heterogeneous mass with lobulated margins measuring approximately 8.7 × 8.2 × 7.4 cm in the lower lobe of right lung []. The mass showed inhomogeneous contrast enhancement at the periphery and decreased attenuation centrally. Ground-glass haze was seen surrounding the mass []. Coarse foci of calcification were seen within the mass. Inferiorly the mass was invading the diaphragm and infiltrating directly into the liver involving segment VII of right lobe of liver [] and [Figure and ]. Postero-laterally, the mass was invading the pleura [] and chest wall with associated pleural thickening and subtle rib erosion, which suggested the mass to be malignant. In addition, multiple bulky lobulated hypodense masses were seen in both lung fields suggesting pulmonary metastases, one of them in right para-vertebral region was invading the mediastinum. Foci of calcification were seen within the larger metastatic masses [Figure and ] and [Figure and ]. Multiple small mediastinal lymph nodes were also seen.\nSequelae to old pulmonary koch's were also seen in form of thick walled cavity and few fibrotic lesions in upper lobes and right middle lobe with foci of calcification within them.\nOn basis of chest CT findings: highly invasive bulky lobulated hypodense mass infiltrating the diaphragm and liver inferiorly and chest wall laterally along with lobulated metastases in both lung fields and coarse foci of calcification within the primary tumor and metastases.- possibility of some sarcomatous component within the primary lung tumor along with metastases was considered. These features are unusual to bronchogenic carcinoma, which usually shows spiculated ill-defined margins and does not usually infiltrate into the liver directly. Amorphous foci of calcification may be seen within the primary bronchogenic carcinoma but is not seen in its metastases.\nUltrasound-guided fine needle aspiration cytology (FNAC) of the primary tumor was done. It showed extensive necrosis and scattered squamous cells having hyperchromatic, pleomorphic nuclei along with few tadpole cells and anucleate squamous cells [] and []. So diagnosis of squamous cell carcinoma was given.\nPatient was referred to another hospital for treatment of malignancy. Fine-needle percutaneous biopsy of the primary tumor was done there under ultrasound guidance. Few neoplastic osteoids and ossification was seen in addition to necrosis and malignant squamous cells. So final diagnosis of carcinosarcoma was made consisting of mainly squamous cell carcinoma and component of osteosarcoma. Foci of calcification seen in the primary tumor and metastasis on chest CT was metaplastic osteosarcomatous component. Patient refused further treatment.