Pulmonary cavitary lesion and haemoptysis: rare aetiology on biopsy

Pleomorphic carcinoma of the lung is a rare form of malignancy that can present similarly to other necrotising cavitary lung diseases. We present a case of a Caucasian woman who presented with recurrent haemoptysis and a right upper lobe cavitary lesion on CT scan. She underwent selective embolisation of the right bronchial artery by interventional radiology to control her haemoptysis. Positron emission tomography/CT scan was performed which showed significant fluorodeoxyglucose uptake in the right upper lobe cavitary lesion. There was a discussion among her providers about the aetiology of this lesion including infection and malignancy. Cultures from bronchoalveolar lavage and blood were negative for infection as the patient underwent right upper lobectomy which showed invasive sarcomatoid pleomorphic carcinoma with a minor component of acinar adenocarcinoma. She was diagnosed with stage IB (T2aN0M0) sarcomatoid pleomorphic carcinoma and underwent adjuvant chemotherapy after her lobectomy with recurrence and metastasis to her stomach and pancreas.