Infarct-Like Spindle Cell Carcinoma of the Lung: Clinicopathologic, Immunohistochemical, and Molecular Analysis of 4 Cases

Pulmonary spindle cell carcinoma is a rare and aggressive malignancy that often mimics benign conditions. We report 4 cases that simulate a pulmonary infarction, 2 of which were misdiagnosed. Patients were 3 men and 1 woman, smokers, presenting chest pain. All cases appeared as pleural-based, solita...

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Bibliographic Details
Published in:International journal of surgical pathology 2020-09, Vol.28 (6), p.616-623
Main Authors: Rossi, Giulio, Nosseir, Sofia, Jocollé, Genny, Sartori, Giuliana, Banchelli, Isabella, Busetti, Stefano, Baldovini, Chiara
Format: Article
Language:English
Subjects:
Aged
Biomarkers, Tumor - analysis
Carcinoma - diagnosis
Carcinoma - genetics
Carcinoma - pathology
Diagnosis, Differential
Female
Histology
Humans
Immunohistochemistry
Lung cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - genetics
Lung Neoplasms - pathology
Male
Pulmonary Infarction - diagnosis
Pulmonary Infarction - pathology
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Summary:Pulmonary spindle cell carcinoma is a rare and aggressive malignancy that often mimics benign conditions. We report 4 cases that simulate a pulmonary infarction, 2 of which were misdiagnosed. Patients were 3 men and 1 woman, smokers, presenting chest pain. All cases appeared as pleural-based, solitary, and rounded nodules. Patients underwent wedge resections followed by adjuvant chemotherapy (3/4) but died of disease. At histology, lesions consisted of widely necrotic nodules surrounded by organizing fibrosis and pleuritis. Examination and immunostains with pan-cytokeratins and epithelial membrane antigen (EMA) revealed atypical spindle cells encircling necrotic tissue and involving the vascular wall. Positive staining with PD-L1 was noted. Molecular analysis showed KRAS (2/4) and TP53 (1/4) mutations, whereas EGFR, ALK, and ROS1 alterations were not detected. Although in a limited series, these cases further evidence the treacherous appearance of spindle cell carcinomas and the need for careful attention when examining pulmonary infarcted tissue, thus requiring extensive sampling, meticulous examination of vascular structures, and immunostaining with cytokeratins.
ISSN:1066-8969
1940-2465
DOI:10.1177/1066896920912471