The observations collected from hematologic examinations of 100 patients with metastatic carcinoma are reported. Histologic evaluation of the marrow needle biopsy and aspirate revealed the biopsy showing clearcut evidence of tumor in 94 patients, while the aspirate was positive in only 43. The other common morphological alterations included fibrosis (87%) and myelosclerosis (67%). Mild anemia was noted in 74 patients of this group and thrombocytopenia in 25 patients out of the 66 whose platelet counts were recorded. Leukoerythroblastosis was noted in only 19 patients out of the 79 patients whose peripheral blood smears were available for examination. The results point to the superiority of the bone marrow biopsy over the aspirate in the diagnosis of metastatic carcinoma. Rather than leukoerythroblastosis which occurred in only 19 of this group, we found mild anemia and thrombocytopenia to be more common.
Background: Pulmonary sarcomatoid carcinoma is a rare type of non-small cell lung cancer with poor prognosis. It is more common in males, has a strong association with smoking, and makes up mere 1.3% of all lung cancers. Our study examined the epidemiology, natural history, and prognostic factors of sarcomatoid lung carcinoma using a population-based registry. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program database was utilized to isolate cases by tumor site and histology codes. The association between clinical and demographic characteristics and long-term survival was assessed. Results: A total of 582 histology confirmed cases were identified between 1973 and 2014. The median age of the patients was 68 years (range 29-96). Of the patients with a known tumor stage (N = 477), 74.8% had regional or distant stage, and 95% of patients with known histologic grade, had poorly or undifferentiated histologic features. 60.8% received surgical intervention. The median overall survival was 12 months (95% CI 9-14 months). In a multivariate analysis, age, sex, and SEER tumor stage were found to be a significant prognostic factors for disease specific survival. The prognosis of sarcomatoid carcinoma of the lung remains dismal, even in patients with resectable disease. Patients who underwent cancer directed surgery (64%) had median survival of 19 months with 1, 5 and 10year survival rates of 63.7%, 33.6% and 28.8% respectively. Those patients who did not undergo cancer directed surgery (36%) had a poorer prognosis with a median survival of 4 months and 1, 5 and 10-year survival rates of 19.8%, 6.7% and 6.7% respectively. Conclusions: Sarcomatoid lung carcinoma often presents as a high grade, advanced malignacy with aggressive behavior and a dire prognosis. Patients are younger and yet have shorter survial times than those with more common lung cancers. Emphasis on new strategies for early detection and identification of additional risk factors, and noval therapies will be important to improve the outcome for patients with this malignancy.
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