Year: 2026
Type: article
Study design: Case Report
Abstract: A chest radiograph (Fig. 1) demonstrated bilateral pleural effusions, more prominent on the left side, with a large anterior mediastinal mass.Contrast-enhanced computed tomography (CECT) of the thorax (Fig. 2) revealed a large lobulated anterior mediastinal mass (4.1 × 9.2 × 5.0 cm) with heterogeneous enhancement, extending from T3 to the T6-T7 disk.It abutted the sternum anteriorly and the ascending aorta, pulmonary trunk, and right atrium posteriorly, with focal loss of fat planes with the anterior chest wall.The right brachiocephalic vein was not visualized, suggesting thrombosis.Multiple heterogeneously enhancing nodules were seen in a subpleural and perifissural distribution across both upper lobes and lower lobes.Ground-glass opacities and mild septal thickening were noted in the bilateral upper lobes.Nodular pleural and pericardial thickening were present.Bilateral moderate pleural effusions were observed.In view of the imaging findings, an ultrasonography (USG)-guided (Fig. 3) core needle biopsy of the anterior mediastinal mass was performed.Histopathological examination (Fig. 4) revealed a biphasic IntroductIonPulmonary sarcomatoid carcinoma is an uncommon and poorly differentiated malignant tumor belonging to the spectrum of nonsmall cell lung cancers.It is defined by the coexistence of carcinomatous and sarcomatous elements within the same neoplasm.Due to its marked morphological and pathological heterogeneity, accurate diagnosis is often challenging.Few cases of sarcomatoid carcinoma involving the anterior mediastinum have been described in the literature. case descrIptIonAn 80-year-old woman, known to have hypertension and with no prior history of smoking, presented with a 5-month history of chest pain, insidious in onset and gradually progressive.The pain was localized, dull-aching in character, nonradiating, and persistent without significant fluctuation.Over the same period, she developed progressive exertional dyspnea, advancing from the modified Medical Research Council (mMRC) grades I to IV, with no diurnal, seasonal, or postural variation.She also reported a chronic cough of 5 months' duration, occasionally accompanied by episodes of hemoptysis, each producing approximately 10-20 mL of fresh blood.There was no history of antitubercular therapy intake, no history of trauma, or prior surgery.On examination, her vital parameters were within normal limits.There was no evidence of peripheral lymphadenopathy.Respiratory system examination revealed reduced chest expansion on the left side, accompanied by diminished vocal fremitus and decreased breath sounds over the same region.Examination of the cardiovascular, abdominal, and nervous systems was unremarkable.Pleural fluid analysis revealed a straw-colored effusion, transudative in nature (protein 2.57 gm/dL; glucose 103 mg/dL; ADA 4.86 U/L), with cytology negative for malignant cells.Laboratory evaluation showed an elevated D-dimer (2.75 µg/mL) and markedly raised NT-proBNP (2,820 pg/mL), while procalcitonin was low (0.042 ng/mL).
Source: Journal of PACS
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7147446947