Advertisement
Journal of Thoracic Oncology
IASLC
Advanced SearchSave search
Image of the Month| Volume 3, ISSUE 5, P532-533, May 01, 2008

Epithelioid Sarcoma Metastatic to the Lung As Pulmonary Cysts Without Other Metastatic Manifestation

Open ArchiveDOI:https://doi.org/10.1097/JTO.0b013e31816e23e6
Epithelioid Sarcoma Metastatic to the Lung As Pulmonary Cysts Without Other Metastatic Manifestation
Previous ArticleB-Cell Non-Hodgkin Lymphoma Presenting As an Endobronchial Polypoid Mass
Next ArticlePrognostic Value of Posttreatment [18F] Fluorodeoxyglucose Uptake of Primary Non-small Cell Lung Carcinoma Treated with Radiation Therapy with or without Chemotherapy: A Brief Review

      Key Words

      A 35-year-old man presented with deep ulceration on the scalp for 3 months. Physical examinations and routine laboratory investigations were unremarkable, except for the noduloulcerative lesion in the right parieto-occipital area (Figure 1).
      Figure thumbnail gr1
      FIGURE 1Noduloulcerative lesion in right parieto-occipital area.
      Microscopically, a skin biopsy revealed this tumor was suggestive of epithelioid sarcoma. Immunohistochemically, the tumor cells stained for cytokeratin, epithelial membrane antigen, vimentin, and CD34 (Figure 2). The specimen stained negative with CD68. Therefore, this lesion was diagnosed as an epithelioid sarcoma.
      Figure thumbnail gr2
      FIGURE 2Skin biopsy specimens. A, The tumor cells were located in the deep dermis with central necrosis (hematoxylin and eosin, ×40). B, Large epithelioid cells with abundant eosinophilic cytoplasm demonstrating moderate cytologic atypia, vesicular nucleoli, and prominent centrally located nucleoli (hematoxylin and eosin, ×200). C, High positivity of cytokeratin in tumor cells (×200). D, High positivity of vimentin in tumor cells (×200).
      Chest radiography revealed no remarkable findings. Chest computed tomography (CT) revealed bilateral multiple thin-walled cysts measuring up to 1.5 cm in diameter (Figures 3A, B). No nodules, pleural lesions, or enlarged lymph nodes were found. Brain CT and positron emission tomography-CT were performed, and no distant metastasis or enlarged lymph nodes were found. The patient underwent video-assisted thoracoscopic surgery to diagnose whether pulmonary cystic mass represented metastatic lesions (Figure 3C). Microscopically, lung biopsy specimen had a same feature of the skin lesion. All tumor cells presented only within the pulmonary interstitium (Figure 4). Immunohistochemically, the tumor cells stained for cytokeratin, epithelial membrane antigen, vimentin, and CD34. The specimen stained negative with CD68 and thyroid transcription factor-1.
      Figure thumbnail gr3
      FIGURE 3Chest computed tomography. A–B, The arrows indicate bilateral multiple pulmonary thin-walled cysts <1.5 cm. C, The arrow indicates the lung biopsy site.
      Figure thumbnail gr4
      FIGURE 4Tumor cells have same features of skin specimen. All tumor cells present within pulmonary interstitium (hematoxylin and eosin, ×200).
      Pulmonary cystic metastasis from epitheloid sarcoma without other metastatic manifestation was extremely rare condition. Two cases of cystic pulmonary metastases of epithelioid sarcomas have been described.
      • Kikuchi E
      • Kinoshita I
      • Yamazaki K
      • et al.
      Epithelioid sarcoma presenting as pulmonary cysts with cancer antigen 125 expression.
      Respirology. 2006; 11: 826-829
      , 
      • Hasegawa S
      • Inui K
      • Kamakari K
      • Kotoura Y
      • Suzuki K
      • Fukumoto M
      Pulmonary cysts as the sole metastatic manifestation of soft tissue sarcoma: case report and consideration of the pathogenesis.
      Chest. 1999; 116: 263-265
      Three possible mechanisms for the development of malignant cysts have been proposed: (i) excavation of a nodular tumor through discharge of the necrotic material inside; (ii) infiltration of malignant cells into the walls of a preexisting benign pulmonary bulla; or (iii) distension of alveoli and small airways by partial bronchial obstruction through the ball-valve effect of the tumor.
      • Kikuchi E
      • Kinoshita I
      • Yamazaki K
      • et al.
      Epithelioid sarcoma presenting as pulmonary cysts with cancer antigen 125 expression.
      Respirology. 2006; 11: 826-829
      , 
      • Hasegawa S
      • Inui K
      • Kamakari K
      • Kotoura Y
      • Suzuki K
      • Fukumoto M
      Pulmonary cysts as the sole metastatic manifestation of soft tissue sarcoma: case report and consideration of the pathogenesis.
      Chest. 1999; 116: 263-265
      The presence of tumor cells within pulmonary interstitium suggests that the pathogenesis of the metastatic cysts in the present case may have involved the third mechanism and it would be early manifestation of hematogenous metastasis of epithelioid sarcomas.

      REFERENCES

        • Kikuchi E
        • Kinoshita I
        • Yamazaki K
        • et al.
        Epithelioid sarcoma presenting as pulmonary cysts with cancer antigen 125 expression.
        Respirology. 2006; 11: 826-829
        View in Article
        • Hasegawa S
        • Inui K
        • Kamakari K
        • Kotoura Y
        • Suzuki K
        • Fukumoto M
        Pulmonary cysts as the sole metastatic manifestation of soft tissue sarcoma: case report and consideration of the pathogenesis.
        Chest. 1999; 116: 263-265
        View in Article

      Article Info

      Footnotes

      Disclosure: This paper was supported through grants from the Catholic University of Korea, College of Medicine.

      Identification

      DOI: https://doi.org/10.1097/JTO.0b013e31816e23e6

      Copyright

      © 2008 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

      User License

      Elsevier user license |
      How you can reuse Information Icon
      Elsevier user license

      Permitted

      For non-commercial purposes:

      • Read, print & download
      • Text & data mine
      • Translate the article

      Not Permitted

      • Reuse portions or extracts from the article in other works
      • Redistribute or republish the final article
      • Sell or re-use for commercial purposes

      Elsevier's open access license policy

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2022 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX