Abstract Introduction Spindle Cell Carcinoma (SpCC) is a subtype accounting for 13.3% of sarcomatoid carcinomas, and 0.4% of all primary lung malignancies. These tumors are aggressive, often with a poor prognosis. We report one such case that was discovered incidentally and promptly resected. Description A 74-year-old male with a history of coronary artery disease, rheumatoid arthritis, and a remote 20-year smoking history presented with aching left-sided back pain for 1 week. Chest CT revealed an incidental 1.5x2.0 cm subpleural homogenous solid nodule in the posteriobasal aspect of the left lower lobe (LLL). Subsequent PET/CT revealed FDG-avidity with a maximum SUV of 19.3 without any extrathoracic FDG-uptake. Histopathology from CT-guided percutaneous biopsy revealed features of high-grade sarcoma. The patient then underwent a robotic-assisted thoracoscopic LLL extended superior segmentectomy and mediastinal lymph node dissection. Final pathology reports revealed malignant spindle cell neoplasm with mediastinal lymph nodes showing no evidence of malignancy. Discussion SpCCs are typically found in elderly male smokers and involve the lung periphery. Presenting symptoms are often nonspecific, and these tumors are radiographically similar to other lung malignancies. About 39% of cases present with locally advanced disease. Histopathology solely shows spindle-shaped tumor cells, with 68% cases showing poor differentiation. SpCC has a poor prognosis even when detected in early stages due to its resistance to chemotherapy and radiotherapy. Overall survival is about 25% for those with localized disease, 9.5% for regional, and only 2.6% for distant metastatic disease. Management depends on staging, and early surgical resection, when possible, can lead to better outcomes. However, given its rarity, definitive therapeutic options are lacking. Combination chemotherapy and radiotherapy are often used as adjunctive treatments, although they are ineffective in inoperable cases. Targeted immunotherapy has recently shown promise given the high expression of PD-1 and PDL-1 in sarcomatoid tumors, although its efficacy in SpCC remains to be seen. Therefore, a thorough pathological and immunohistochemical analysis is required. Although our patient was detected at an early stage without metastatic evidence, adjuvant chemotherapy was not recommended given limited benefit in sarcoma 5cm in size and negative margins. Further management is to be determined at this time pending further evaluation. SpCC demonstrates high rates of recurrence, which necessitates frequent surveillance. There are relatively few cases reported of isolated spindle cell carcinoma without evidence of spread, and this case further highlights how small, isolated pulmonary nodules may be hiding an aggressive malignancy, warranting vigilance and early evaluation. This abstract is funded by: None
Rizvee et al. (Fri,) studied this question.