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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(03): 390-404
DOI: 10.1055/s-0043-1777834
Original Article

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Supraja Laguduva Mohan
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Ekta Dhamija 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Sameer Bakhshi
2   Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Prabhat Singh Malik
2   Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Sameer Rastogi
2   Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Chandrashekhara Sheragaru Hanumanthappa
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Deepali Jain
3   Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
,
Rambha Pandey
4   Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Background Primary lung sarcoma (PLS) differs in management protocols and prognosis from the more common primary lung carcinoma (PLC). It becomes imperative to raise a high index of suspicion on radiological and pathological features.

Purpose The aim of this study is to highlight the variable imaging appearances of PLS compared with PLC, which impacts radiologic - pathologic correlation.

Materials and Methods A retrospective observational study of 68 patients with biopsy-proven lung tumors who underwent baseline imaging at our tertiary care cancer hospital was conducted between January 2018 and March 2022. The patient details and imaging parameters of the mass on contrast-enhanced computed tomography (CECT) were recorded and analyzed for patients with PLS and compared with PLC. Follow-up imaging was available in 9/12 PLS and 52/56 PLC patients.

Results Among 12 patients with PLS, 5 patients had synovial sarcoma on histopathology. PLS was seen in patients with a mean age of 40.8 years; the mass showed a mean size of 13.2 cm, lower lobe (75%), parahilar (75%), hilar involvement (41.7%), oval shape (41.7%), circumscribed (25%) or lobulated (75%) margins, lower mean postcontrast attenuation of 57.3 HU, fissural extension (50%), calcification (50%), and no organ metastasis other than to the lung. PLC (56 patients) was seen in the elderly with a mean age of 54.8 years; the mass showed a mean size of 5.7 cm, irregular shape (83.9%), spiculated margins (73.2%), higher mean postcontrast attenuation (77.3 HU), chest wall infiltration (30.4%), and distant metastasis (58.9%) at baseline imaging. A statistically significant difference (p < 0.05) was seen between sarcoma and carcinoma in the mean age, size, site, shape, margins, postcontrast attenuation, presence of calcifications, fissural extension, and distant metastasis.

Conclusion The distinct imaging features of sarcoma help in differentiating it from carcinoma. This can also be used to corroborate with histopathology to achieve concordance and guide clinicians on further approach.

Keywords

lung neoplasms - carcinoma - sarcoma - synovial sarcoma - SYT–SSX fusion protein


Publication History

Article published online:
17 January 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 2011; 32 (04) 605-644
    CrossrefPubMedGoogle Scholar
  • 2 Travis WD. Pathology of lung cancer. Clin Chest Med 2011; 32 (04) 669-692
    CrossrefPubMedGoogle Scholar
  • 3 Inamura K. Lung cancer: understanding its molecular pathology and the 2015 WHO classification. Front Oncol 2017; 7: 193
    CrossrefPubMedGoogle Scholar
  • 4 Hashimoto H, Tsugeno Y, Sugita K, Inamura K. Mesenchymal tumors of the lung: diagnostic pathology, molecular pathogenesis, and identified biomarkers. J Thorac Dis 2019; 11 (Suppl. 01) S9-S24
    CrossrefPubMedGoogle Scholar
  • 5 Tomlinson J, Barsky SH, Nelson S. et al. Different patterns of angiogenesis in sarcomas and carcinomas. Clin Cancer Res 1999; 5 (11) 3516-3522
    PubMedGoogle Scholar
  • 6 Hlatky L, Hahnfeldt P, Folkman J. Clinical application of antiangiogenic therapy: microvessel density, what it does and doesn't tell us. J Natl Cancer Inst 2002; 94 (12) 883-893
    CrossrefPubMedGoogle Scholar
  • 7 Birau A, Ceausu RA, Cimpean AM, Gaje P, Raica M, Olariu T. Assessement of angiogenesis reveals blood vessel heterogeneity in lung carcinoma. Oncol Lett 2012; 4 (06) 1183-1186
    CrossrefPubMedGoogle Scholar
  • 8 Gladish GW, Sabloff BM, Munden RF, Truong MT, Erasmus JJ, Chasen MH. Primary thoracic sarcomas. Radiographics 2002; 22 (03) 621-637
    CrossrefPubMedGoogle Scholar
  • 9 Nicholson AG, Tsao MS, Beasley MB. et al. The 2021 WHO classification of lung tumors: impact of advances since 2015. J Thorac Oncol 2022; 17 (03) 362-387
    CrossrefPubMedGoogle Scholar
  • 10 Postmus PE, Kerr KM, Oudkerk M. et al; ESMO Guidelines Committee. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 04) iv1-iv21
    CrossrefPubMedGoogle Scholar
  • 11 Dennison S, Weppler E, Giacoppe G. Primary pulmonary synovial sarcoma: a case report and review of current diagnostic and therapeutic standards. Oncologist 2004; 9 (03) 339-342
    CrossrefPubMedGoogle Scholar
  • 12 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
    Google Scholar
  • 13 Régnard JF, Icard P, Guibert L, de Montpreville VT, Magdeleinat P, Levasseur P. Prognostic factors and results after surgical treatment of primary sarcomas of the lung. Ann Thorac Surg 1999; 68 (01) 227-231
    CrossrefPubMedGoogle Scholar
  • 14 Porte HL, Metois DG, Leroy X, Conti M, Gosselin B, Wurtz A. Surgical treatment of primary sarcoma of the lung. Eur J Cardiothorac Surg 2000; 18 (02) 136-142
    CrossrefPubMedGoogle Scholar
  • 15 Snoeckx A, Reyntiens P, Desbuquoit D. et al. Evaluation of the solitary pulmonary nodule: size matters, but do not ignore the power of morphology. Insights Imaging 2018; 9 (01) 73-86
    CrossrefPubMedGoogle Scholar
  • 16 Gurney JW. Determining the likelihood of malignancy in solitary pulmonary nodules with bayesian analysis. Part I. Theory. Radiology 1993; 186 (02) 405-413
    CrossrefPubMedGoogle Scholar
  • 17 Ratto GB, Piacenza G, Frola C. et al. Chest wall involvement by lung cancer: computed tomographic detection and results of operation. Ann Thorac Surg 1991; 51 (02) 182-188
    CrossrefPubMedGoogle Scholar
  • 18 Glazer HS, Kaiser LR, Anderson DJ. et al. Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation. Radiology 1989; 173 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 19 Panunzio A, Sartori P. Lung cancer and radiological imaging. Curr Radiopharm 2020; 13 (03) 238-242
    CrossrefPubMedGoogle Scholar
  • 20 Etienne-Mastroianni B, Falchero L, Chalabreysse L. et al. Primary sarcomas of the lung: a clinicopathologic study of 12 cases. Lung Cancer 2002; 38 (03) 283-289
    CrossrefPubMedGoogle Scholar
  • 21 Sbaraglia M, Bellan E, Dei Tos AP. The 2020 WHO classification of soft tissue tumours: news and perspectives. Pathologica 2021; 113 (02) 70-84
    CrossrefPubMedGoogle Scholar
  • 22 Frazier AA, Franks TJ, Pugatch RD, Galvin JR. From the archives of the AFIP: pleuropulmonary synovial sarcoma. Radiographics 2006; 26 (03) 923-940
    CrossrefPubMedGoogle Scholar
  • 23 Essary LR, Vargas SO, Fletcher CDM. Primary pleuropulmonary synovial sarcoma: reappraisal of a recently described anatomic subset. Cancer 2002; 94 (02) 459-469
    CrossrefPubMedGoogle Scholar
  • 24 Hisaoka M, Hashimoto H, Iwamasa T, Ishikawa K, Aoki T. Primary synovial sarcoma of the lung: report of two cases confirmed by molecular detection of SYT-SSX fusion gene transcripts. Histopathology 1999; 34 (03) 205-210
    CrossrefPubMedGoogle Scholar
  • 25 Leonard R, Schultz C, Hadique S. An unusual endobronchial lesion: expanding the differential diagnosis. Respirol Case Rep 2019; 7 (05) e0429
    CrossrefPubMedGoogle Scholar
  • 26 Hartel PH, Fanburg-Smith JC, Frazier AA. et al. Primary pulmonary and mediastinal synovial sarcoma: a clinicopathologic study of 60 cases and comparison with five prior series. Mod Pathol 2007; 20 (07) 760-769
    CrossrefPubMedGoogle Scholar
  • 27 Stacchiotti S, Van Tine BA. Synovial sarcoma: current concepts and future perspectives. J Clin Oncol 2018; 36 (02) 180-187
    CrossrefPubMedGoogle Scholar
  • 28 Ten Heuvel SE, Hoekstra HJ, Suurmeijer AJH. Diagnostic accuracy of FISH and RT-PCR in 50 routinely processed synovial sarcomas. Appl Immunohistochem Mol Morphol 2008; 16 (03) 246-250
    CrossrefPubMedGoogle Scholar
  • 29 Takahashi D, Nagayama J, Nagatoshi Y. et al. Primary Ewing's sarcoma family tumors of the lung a case report and review of the literature. Jpn J Clin Oncol 2007; 37 (11) 874-877
    CrossrefPubMedGoogle Scholar
  • 30 Weissferdt A. Pulmonary sarcomatoid carcinomas: a review. Adv Anat Pathol 2018; 25 (05) 304-313
    CrossrefPubMedGoogle Scholar
  • 31 Roesel C, Terjung S, Weinreich G. et al. Sarcomatoid carcinoma of the lung: a rare histological subtype of non-small cell lung cancer with a poor prognosis even at earlier tumour stages. Interact Cardiovasc Thorac Surg 2017; 24 (03) 407-413
    PubMedGoogle Scholar
  • 32 Chen M, Yang J, Zhu L, Zhou C, Zhao H. Primary intrathoracic liposarcoma: a clinicopathologic study and prognostic analysis of 23 cases. J Cardiothorac Surg 2014; 9: 119
    CrossrefPubMedGoogle Scholar
  • 33 Panagiotopoulos N, Patrini D, Gvinianidze L, Woo WL, Borg E, Lawrence D. Inflammatory myofibroblastic tumour of the lung: a reactive lesion or a true neoplasm?. J Thorac Dis 2015; 7 (05) 908-911
    PubMedGoogle Scholar
  • 34 Perret R, Chalabreysse L, Watson S. et al. SMARCA4-deficient thoracic sarcomas: clinicopathologic study of 30 cases with an emphasis on their nosology and differential diagnoses. Am J Surg Pathol 2019; 43 (04) 455-465
    CrossrefPubMedGoogle Scholar
  • 35 Fois AG, Pirina P, Arcadu A. et al. Desmoplastic small round cell tumors of the pleura: a review of the clinical literature. Multidiscip Respir Med 2017; 12: 22
    CrossrefPubMedGoogle Scholar
  • 36 Hollings N, Shaw P. Diagnostic imaging of lung cancer. Eur Respir J 2002; 19 (04) 722-742
    CrossrefPubMedGoogle Scholar
  • 37 Quint LE, Tummala S, Brisson LJ. et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996; 62 (01) 246-250
    CrossrefPubMedGoogle Scholar
  • 38 Im Y, Lee H, Lee HY. et al. Prognosis of pulmonary lymphangitic carcinomatosis in patients with non-small cell lung cancer. Transl Lung Cancer Res 2021; 10 (11) 4130-4140
    CrossrefPubMedGoogle Scholar
  • 39 Gołota J, Osowiecka K, Orłowski T. Primary pulmonary sarcoma: treatment outcomes depending on the different types of radical operation. Kardiochir Torakochirurgia Pol 2019; 16 (01) 1-6
    PubMedGoogle Scholar
  • 40 Takada K, Sugita S, Murase K. et al. Exceptionally rapid response to pembrolizumab in a SMARCA4-deficient thoracic sarcoma overexpressing PD-L1: a case report. Thorac Cancer 2019; 10 (12) 2312-2315
    CrossrefPubMedGoogle Scholar
  • 41 Kim GH, Kim MY, Koo HJ, Song JS, Choi CM. Primary pulmonary synovial sarcoma in a tertiary referral center: clinical characteristics, CT, and 18F-FDG PET findings, with pathologic correlations. Medicine (Baltimore) 2015; 94 (34) e1392
    CrossrefPubMedGoogle Scholar
  • 42 Zhang WD, Guan YB, Chen YF, Li CX. CT imaging of primary pleuropulmonary synovial sarcoma. Clin Radiol 2012; 67 (09) 884-888
    CrossrefPubMedGoogle Scholar
  • 43 Baheti AD, Sewatkar R, Hornick JL. et al. Imaging features of primary and recurrent intrathoracic synovial sarcoma: a single-institute experience. Clin Imaging 2015; 39 (05) 803-808
    CrossrefPubMedGoogle Scholar