Pneumonectomy for an endobronchial carcinosarcoma with long-term survival: a case report

Endobronchial carcinosarcoma is a rare and highly malignant tumor composed of both carcinomatous and sarcomatous elements. It typically affects middle-aged and elderly men, particularly those with a history of smoking. The prognosis is generally poor due to its high potential for early metastasis and local recurrence. This case report is unique due to the presentation of endobronchial carcinosarcoma, exhibiting a gloved finger sign, coarse calcifications, and high ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake, along with an exceptionally favorable long-term survival after pneumonectomy (R0) without any neoadjuvant or adjuvant therapy.

A 48-year-old man with a 30-year history of chronic productive cough, a 1-month history of shortness of breath, and a significant smoking history presented to The First Affiliated Hospital of Guangzhou Medical University. Initial examinations revealed elevated neuron-specific enolase (NSE) and reduced partial pressure of oxygen. Computed tomography identified a branching tubular mass in the left upper lobe with a gloved finger sign and coarse calcifications. ¹⁸F-FDG positron emission tomography/computed tomography showed intense FDG uptake. Preoperative imaging showed atelectasis and pleural effusion. A bronchoscopic biopsy suggested carcinosarcoma, which was confirmed post-pneumonectomy. Pathological examination confirmed complete surgical resection (R0). Microscopic analysis revealed a mix of squamous cell carcinoma and sarcoma components, primarily osteosarcoma and chondrosarcoma. The patient has remained free of recurrence or metastasis for 7 years post-surgery, without any neoadjuvant or adjuvant therapy.

This case illustrates that the gloved finger sign may reflect early bronchial obstruction and prompt clinical evaluation. Despite preoperative imaging suggestive of disease progression, the patient underwent R0 pneumonectomy and has remained recurrence-free for 7 years without receiving neoadjuvant or adjuvant therapy. Exceptional long-term survival after R0 resection alone may be possible in some certain patients.