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Resumen El carcinoma sarcomatoide primario hepático es un tumor agresivo que representa el 0.4-0.7% de todas las neoplasias primarias hepáticas. Se asocia a hepa topatía por virus hepatotropos, es más prevalente en la población asiática y en su histología se evidencian componentes de carcinoma y sarcoma. No posee carac terísticas clínicas ni imagenológicas patognomónicas y su diagnóstico se realiza en base a los hallazgos de la anatomía patológica e inmunohistoquímica. La cirugía en estadio localizado representa la única modalidad terapéutica con impacto en la sobrevida. Reportamos el caso de una paciente de 72 años, coreana, con an tecedentes de hepatopatía crónica por virus B, a quien se le diagnosticó un carcinoma sarcomatoide hepático primario con metástasis ósea y ganglionares.
Abstract Primary hepatic sarcomatoid carcinoma is a very ag gressive tumor, representing 0.4-0.7% of all primary he patic neoplasms. The disease is associated with liver dis ease due to hepatotropic viruses and is more prevalent in Asians. Histology shows sarcomatous and carcinoma components. It does not have pathognomonic clinical or imaging characteristics and its diagnosis is based on the pathological and immunohistochemistry findings. Surgery could prolong survival in localized stages. We report the case of a 72-year-old Korean patient with a history of chronic liver disease due to B virus, who was diagnosed with primary hepatic sarcomatoid carcinoma with bone and lymph node metastases.
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Primary hepatic sarcomatoid carcinoma is a very aggressive tumor, representing 0.4-0.7% of all primary hepatic neoplasms. The disease is associated with liver disease due to hepatotropic viruses and is more prevalent in Asians. Histology shows sarcomatous and carcinoma components. It does not have pathognomonic clinical or imaging characteristics and its diagnosis is based on the pathological and immunohistochemistry findings. Surgery could prolong survival in localized stages. We report the case of a 72-year-old Korean patient with a history of chronic liver disease due to B virus, who was diagnosed with primary hepatic sarcomatoid carcinoma with bone and lymph node metastases.
El carcinoma sarcomatoide primario hepático es un tumor agresivo que representa el 0.4-0.7% de todas las neoplasias primarias hepáticas. Se asocia a hepatopatía por virus hepatotropos, es más prevalente en la población asiática y en su histología se evidencian componentes de carcinoma y sarcoma. No posee características clínicas ni imagenológicas patognomónicas y su diagnóstico se realiza en base a los hallazgos de la anatomía patológica e inmunohistoquímica. La cirugía en estadio localizado representa la única modalidad terapéutica con impacto en la sobrevida. Reportamos el caso de una paciente de 72 años, coreana, con antecedentes de hepatopatía crónica por virus B, a quien se le diagnosticó un carcinoma sarcomatoide hepático primario con metástasis ósea y ganglionares.
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Neoplasias Hepáticas , Humanos , Idoso , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Metástase Linfática/patologia , Carcinossarcoma/patologia , Carcinossarcoma/diagnóstico por imagemRESUMO
Resumen ANTECEDENTES: El cáncer epidermoide cutáneo de tipo sarcomatoide es una neoplasia rara, de bajo riesgo de malignidad, con menos del 2% de riesgo de metástasis. Su comportamiento agresivo es inusual y casi siempre asociado con factores que favorecen su malignidad. La metástasis a la placenta es también excepcional: hasta la actualidad solo se han reportado 61 casos. CASO CLÍNICO: Paciente de 35 años con antecedentes de dos embarazos, en curso de las 33 semanas de gestación, carcinoma epidermoide infiltrante en la pierna izquierda, con amputación supracondílea y metástasis pulmonar. Ingresó a urgencias por dificultad respiratoria, sin trabajo de parto, taquicárdica y taquipneica. Se decidió la cesárea con obtención de nacido vivo, de sexo femenino, 1860 g, sin complicaciones. Luego de la intervención, la paciente fue trasladada a una institución especializada en atención oncológica, donde falleció a las 24 horas. La recién nacida se dio de alta sin complicaciones y sin manifestaciones oncológicas o de otro tipo hasta el año de nacida. CONCLUSIONES: Luego de una búsqueda exhaustiva en la bibliografía los autores consideran que el caso aquí comunicado es el primero en Perú de cáncer epidermoide cutáneo de tipo sarcomatoide con metástasis a la placenta.
Abstract BACKGROUND: Sarcomatoid cutaneous epidermoid cancer is a rare neoplasm, with a low risk of malignancy and less than 2% risk of metastasis. Its aggressive behavior is unusual and almost always associated with factors favoring its malignancy. Placental metastasis is also exceptional: only 61 cases have been reported to date. CLINICAL CASE: 35-year-old female patient, with a history of two pregnancies, in 33 weeks of gestation, infiltrating squamous cell carcinoma of the left leg, with supracondylar amputation and pulmonary metastasis. She was admitted to the emergency room for respiratory distress, without labor, tachycardic and tachypneic. It was decided to perform a cesarean section with live birth, female, 1860 g, without complications. After the intervention, the patient was transferred to an institution specialized in oncologic care, where she died 24 hours later. The newborn was discharged without complications and without oncologic or other manifestations up to one year of age. CONCLUSIONS: After an exhaustive search of the literature, the authors consider the case reported here to be the first case of sarcomatoid epidermoid skin cancer with metastasis to the placenta.
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INTRODUCTION: Sarcomatoid urothelial carcinoma (SUC) is a rare and aggressive variant of bladder cancer with limited data regarding epidemiology and survival. In this study, we explored clinicopathologic factors and oncologic outcomes of patients with SUC derived from Survival, Epidemiology and End Results (SEER) database, in comparison to conventional UC (CUC). MATERIALS AND METHODS: SEER database was searched for patients with invasive (≥T1) SUC or CUC using the topography codes C67.0 to C67.9 for bladder cancer and the morphologic codes 8120/8122 for CUC/SUC respectively. Demographic/clinicopathologic/treatment/survival data were extracted. Disease-specific survival (DSS) was estimated with the Kaplan-Meier method. Chi-squared tests were used for comparative analysis and Cox proportional hazards model for identifying clinical covariates associated with DSS. RESULTS: A total of 569 patients with SUC and 37,740 with CUC were identified. Overall, there was a male predominant population in both cohorts, although a higher proportion of women were noted in the SUC cohort (32 vs. 25%). Patients with SUC had significantly higher incidence of non-bladder confined disease (T3/4, 37% vs. 22%) and nodal invasion (18% vs. 12%) in comparison to those with CUC (all P < .05). Median DSS was 16 months (95% CI: 12.4-19.6) in the SUC vs. 82 months (95% CI; 75.9-88.1) in the CUC cohort. Presence of SUC histology was independently associated with shorter DSS in the multivariate analysis, when adjusted for other significant clinicopathologic factors. CONCLUSION: SUC was associated with advanced stage and shorter DSS compared to CUC. Further studies are needed to better understand biological underpinnings behind its aggressive behavior and the role of novel systemic treatments.
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Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/patologiaRESUMO
OBJECTIVES: Pulmonary sarcomatoid carcinoma (PSC) is a rarely occurring variant of non-small cell lung cancer with sarcoma-like features. Compared with traditional non-small cell lung cancer, PSC patients typically present later and have poorer prognoses, irrespective of stage. The standard of care is resection, but guidelines for the use of adjuvant chemotherapy have not been established. To advance the development of evidence-based management algorithms for PSC after resection, a statistical analysis on a nationwide representative sample of patients was performed. METHODS: A retrospective cohort study was performed by querying the National Cancer Database for patients with a diagnosis of PSC between 2004 and 2015. Patients who received complete anatomical resection with or without adjuvant chemotherapy were included. Multivariable regression was used to detect factors associated with the receipt of adjuvant chemotherapy. Multivariable Cox regression of overall survival and Kaplan-Meier survival analysis on propensity-matched groups was conducted to study the association between adjuvant chemotherapy and prognosis. RESULTS: We included 1497 patients with PSC in the final analysis. Factors associated with receiving adjuvant chemotherapy were age, histology, and receipt of adjuvant radiation. The results of multivariable Cox analysis and Kaplan-Meier analysis on propensity matched groups yielded similar trends: adjuvant chemotherapy was associated with improved 5-year overall survival for stage II and III disease, but not for stage I disease. CONCLUSIONS: Multiple factors are associated with receipt of adjuvant chemotherapy for PSC, and this treatment appears to be associated with improved survival in stage II and stage III, but not stage I patients.
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Carcinoma Pulmonar de Células não Pequenas , Carcinoma , Neoplasias Pulmonares , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Carcinoma/cirurgia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Quimioterapia Adjuvante , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.
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BACKGROUND: Sarcomatoid carcinoma of the pancreas (SCP) is a rare type of pancreatic neoplasm, and only a few cases have been described in the literature. Histologically, it is composed mostly of atypical spindle cells with apparent sarcomatous features. CASE SUMMARY: This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain. Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy. En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor. Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion. After surgery, the patient did not receive chemotherapy. Previous studies indicate a poor prognosis for this type of malignancy. However, our patient has survived for 35 mo with no recurrence to date. CONCLUSION: The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.
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Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.
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Humanos , Masculino , Idoso , Neoplasias Penianas/patologia , Carcinoma de Células Escamosas , Carcinoma VerrucosoRESUMO
ANTECEDENTES: El carcinoma renal con diferenciación sarcomatoide confiere un pronóstico sombrío por su evolución metastásica; a mucosa oral corresponde menos del 1%. CASO CLÍNICO: Mujer de 66 años, tumor dependiente de riñón izquierdo con reporte de patología de carcinoma renal de células claras patrón sarcomatoide, tumor gingival en maxilar izquierdo, biopsia con metástasis de células claras sarcomatoide. Recibió radioterapia local. Progresó con metástasis a sistema nervioso central, pulmonar, mediastinal y suprarrenal. CONCLUSIONES: La presentación clínica de tumores renales en la mucosa oral es rara. La presencia de diferenciación sarcomatoide implica un reto terapéutico por la respuesta a las terapias sistémicas existentes. Los avances en fármacos con actividad inmunitaria podrían mejorar las tasas de respuesta. BACKGROUND: The renal carcinoma with sarcomatoid differentiation confers a poor prognosis due to its metastatic evolution, less than 1% corresponds to oral mucosa. CASE REPORT: 66 year old female, left kidney tumor, with pathology report clear cell renal carcinoma, with sarcomatoid pattern, gingival tumor in the left maxilla, biopsy with sarcomatoid metastases, received local radiotherapy. It progressed with metastases to the central nervous system, pulmonary, mediastinal and adrenal. . CONCLUSIONS: The clinical presentation of kidney tumors in oral mucosa is rare, the presence of sarcomatoid differentiation implies a therapeutic challenge due to the response to existing systemic therapies, advances in drugs with immunological activity could improve response rates.
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Adenocarcinoma de Células Claras , Neoplasias Colorretais , Sarcoma , Neoplasias de Tecidos Moles , Idoso , Biópsia , Feminino , HumanosRESUMO
Of the 3 major histologic types of malignant paratesticular mesothelioma (MPM) (epithelial, sarcomatoid, and biphasic), many cases of epithelial and biphasic mesothelioma have been reported in the literature. Pure sarcomatoid MPM is the least common but the most aggressive of the 3 major histologic types of mesothelioma cells. It is limited to only 2 cases in the literature The sarcomatoid type of MPM can be confused clinically and histologically with true sarcomas because it is rarely seen. We present a case who had been exposed to asbestos for years due to his involvement in the dry-cleaning industry and who was diagnosed with the sarcomatoid type of MPM but had a relatively prolonged survival not usually seen with this tumor. This report also emphasizes the significance of an immunohistochemical examination, focusing especially on the diagnostic role of WT-1.
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Mesotelioma Maligno/diagnóstico , Sarcoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Amianto/toxicidade , Humanos , Masculino , Mesotelioma Maligno/patologia , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Sarcoma/patologia , Neoplasias Testiculares/patologia , Proteínas WT1/análiseRESUMO
Spindle cell carcinoma (SpCC) is a rare tumor, which occurs in upper respiratory tract, mainly in larynx. This study aimed to review the clinical and pathological characteristics for diagnosis and prognosis. Retrospective cohort study. All patients with SpCC in upper respiratory tract treated for curative intent was included. All patients were reviewed in search of epithelial component and immunohistochemistry when not found. It was evaluated rate of recurrence and disease-free survival with univariate and multivariate analysis with Kaplan Meier and Cox Regression model adjusted to propensity score indexes (PSI) according to age, gender, site of tumor, stage, surgical treatment, status of margins of surgical resection, lymphatic invasion. There were 16 cases of SpCC.31% were diagnosed with light microscopy and others with immunohistochemistry for epithelial marker. Disease-free survival was higher in early stage disease in univariate and multivariate analysis, as the main prognostic factor. Surgical treatment increases in 2.54 the rate of survival. The SpCC is a rare tumor considered a highly malignant variant of squamous cell carcinoma. It has male predominance and tobacco use as risk factors. Its treatment should follow the same recommendations for squamous cell carcinoma, with surgery as the maintain treatment. Immunohistochemistry is an adjuvant important tool for diagnosis of SpCC.
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Carcinossarcoma/diagnóstico , Carcinossarcoma/patologia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Idoso , Carcinossarcoma/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Laríngeas/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/mortalidade , Estudos RetrospectivosRESUMO
INTRODUCTION: For the 3 histologic subtypes of malignant pleural mesothelioma (MPM)-epithelioid, sarcomatoid, and biphasic-the magnitude of benefit with surgical management remains underdefined. MATERIALS AND METHODS: The National Cancer Data Base was queried for newly diagnosed nonmetastatic MPM with known histology. Patients in each histologic group were dichotomized into those receiving gross macroscopic resection versus lack thereof/no surgery. Kaplan-Meier analysis evaluated overall survival (OS) between cohorts; multivariable Cox proportional hazards modeling assessed factors associated with OS. After propensity matching, survival was evaluated for each histologic subtype with and without surgery. RESULTS: Overall, 4207 patients (68% epithelioid, 18% sarcomatoid, 13% biphasic) met the study criteria. Before propensity matching, patients with epithelioid disease experienced the highest median OS (14.4 months), followed by biphasic (9.5 months) and sarcomatoid (5.3 months) disease; this also persisted after propensity matching (P < .001). After propensity matching, surgery was associated with significantly improved OS for epithelioid (20.9 vs. 14.7 months, P < .001) and biphasic (14.5 vs. 8.8 months, P = .013) but not sarcomatoid (11.2 vs. 6.5 months, P = .140) disease. On multivariable analysis, factors predictive of poorer OS included advanced age, male gender, uninsured status, urban residence, treatment at community centers, and T4/N2 disease (all P < .05). Chemotherapy and surgery were independently associated with improved OS, as was histology (all P < .001). CONCLUSION: This large investigation evaluated surgical practice patterns and survival by histology for MPM and found that histology independently affects survival. Gross macroscopic resection is associated with significantly increased survival in epithelioid and biphasic, but not sarcomatoid, disease. However, the decision to perform surgery should continue to be individualized in light of available randomized data.
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Carcinoma/cirurgia , Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Neoplasias Pleurais/cirurgia , Sarcoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/mortalidade , Carcinoma/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/mortalidade , Mesotelioma/patologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Neoplasias Pleurais/mortalidade , Neoplasias Pleurais/patologia , Prognóstico , Fatores de Risco , Sarcoma/mortalidade , Sarcoma/patologia , Análise de SobrevidaRESUMO
Several different histological subtypes of penile carcinoma had been described in the last decades, many with different biological behavior and prognosis. The association of two histological subtypes (mixed tumors) can be observed in one third of the cases. The most common association is of warty and basaloid tumors, two HPV-related carcinomas. Here, we described a mixed papillary-sarcomatoid carcinoma, never reported before. Although it is a clinical aspect of a low-grade verruciform tumor, its prognosis showed it to be very aggressive due to the sarcomatoid component hidden above the papillary component. The two components showed opposite cadherin/vimentin expression pointed to epithelial-mesenchymal transition between them.
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Carcinoma/patologia , Neoplasias Penianas/patologia , Idoso , Transição Epitelial-Mesenquimal , Humanos , MasculinoRESUMO
El carcinoma renal con diferenciación sarcomatoide es una entidad rara con muy pocos casos reportados en la literatura. Se presenta un caso de un paciente masculino de 65 años que por historia de hematuria macroscópica, se le realizan estudios diagnósticos, reportándose masa renal izquierda, efectuándos ele nefrectomía radical cuyo resultado de patología fue un carcinoma de células claras. Tres meses después de la cirugía el paciente refiere dolor localizado en el mismo sitio anatómico por lo que se le realiza tomografía, reportándose masa a nivel del retroperitoneo, debido a este hallazgo se decide efectuar tumorectomía, en la que se reporta sarcoma fusocelular de alto grado. Los resultados patológicos no corresponden a dos entidades patológicas diferentes, sino al mismo origen tumoral, con progresión de la enfermedad.
Sarcomatoid diferentaton in renal cell carcinoma is a rare disease with very few cases reported in the literature. A 65 year old man with hematuria anda lef renal mass underwent radical nephrectomy. Pathology reported a clear renal cell carcinoma. Three months afer surgery, the patent presentedwith abdominal complaints and a CT scan of the abdomen revealing fndings consistent with a retroperitoneal mass. The patent underwent a secondsurgical resecton and pathology revealed a high grade spindle cell sarcoma. The two diferent pathology reports are not two diferent pathologies; sarcomatoid diferentaton in renal cell carcinoma represents a common pathway of de-diferentaton of renal tumors.
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Masculino , Carcinoma de Células Renais/patologia , Hematúria/complicações , Hematúria/fisiopatologia , Nefrectomia/efeitos adversos , Neoplasias Renais/cirurgiaRESUMO
El carcinosarcoma es un tumor poco frecuente, bifásico, que ha sido comunicado en diferentes sitios del organismo. Está compuesto por un componente maligno epitelial íntimamente asociado con un componente epitelial sarcomatoide que puede ser homólogo y heterólogo. Existen carcinosarcomas cutáneos y extracutáneos. Los carcinosarcomas extracutáneos muestran un pronóstico pobre. Presentamos un paciente de 75 años, fototipo II, que consulta por presentar un tumor exofítico angiomatoide sangrante de 8 mm, de aspecto botriomicoide, de 2 meses de evolución en piel frontal derecha. Se confirma con biopsia y técnicas de inmunohistoquímica la existencia de 2 morfologías celulares típicas del carcinosarcoma. El tumor fue extirpado con un centímetro de margen de seguridad. El paciente, al año de su intervención, está libre de recurrencias y metástasis. El componente sarcomatoso del tumor es comprendido como una transformación metaplásica del componente carcinomatoso. Estos tumores son potencialmente agresivos.
Carcinosarcoma is an uncommon biphasic neoplasm that has been reported in diverseanatomical sites. This tumor is composed of two malignant epithelial components: onetypical and the other atypical, this one resembling mesenchymal tissue. Both are intimatelyassociated .The latter may be homologous or heterologous. When these tumors are locatedat extracutaneous sites, they are characteristically aggressive.We report a 75-year-old man who developed a solitary reddish bleeding nodule that quicklygrew in a two-months period. It resembled a pyogenic granuloma and was located on hisright frontal skin. Clinical, histologycal and immunohistochemical features were evaluated.The tumor was completely excised with a one-centimeter safety margin, and after a lapse ofone year he is free of local relapses or metastases.The sarcomatous component of the tumor is considered to be a metaplastic transformation ofthe carcinomatous component. These tumors are potentially aggressive if partially removed,thus complete excision is mandatory.
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Humanos , Idoso , Carcinossarcoma/cirurgia , Carcinossarcoma/diagnóstico , Carcinossarcoma/patologia , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/patologia , Diagnóstico DiferencialRESUMO
El carcinoma sarcomatoide de mama es una variante histológica del carcinoma metaplásico, compuesto predominantemente por células fusiformes. Presentamos el caso de un tumor en mujer de 54 años, en que las características clínicas y de imagen sugerían un tumor maligno, y finalmente la histología y la inmuno-histoquímica confirmaron el diagnóstico de carcinoma sarcomatoide monofásico. En esta variante no es posible identificar un componente epitelial claro, por lo que plantea problemas de diagnóstico diferencial con sarcomas y otras lesiones mesenquimatosas. La demostración mediante inmunohistoquímica de la naturaleza epitelial de las células fusiformes, resultó fundamental para establecer el diagnóstico.
Sarcomatoid carcinoma of the breast is a histological variant of metaplastic carcinoma, composed predominantly of spindle cells. We report a case of a tumor in a woman of 54 years old, which suggested a clinical and radiological malignant tumor. Finally the histology and immunohistochemistry confirmed the diagnostic of monophasic sarcomatoid carcinoma. In this variant of sarcomatoid carcinoma, is not possible to identify a clear epithelial component, creating problems of differential diagnosis between sarcomas and other mesenchymal damages. The immunohistochemical demonstration of epithelial nature of the spindle cells was essential for the diagnosis.