title: [A case of carcinoma with sarcomatoid elements in the middle mediastinum].
abstract: We describe a 63-year-old man who, while under treatment as an outpatient for adult onset Still's disease (AOSD), developed edema of the extremities and mediastinal tumor was observed on a chest X-ray film and a chest CT scan. He was not pathologically diagnosed at first and received radiation therapy with a total dose of 30 Gy. Transbronchial biopsy was carried out because the tumor enlarged, and the tumor invasion was observed in the left lumen of the main bronchus. Histological findings suggested a diagnosis of carcinoma with sarcomatoid elements (CSE). Further radiation therapy with a dose of 20 Gy was unsuccessful; his condition gradually worsened and the patient died. The autopsy findings demonstrated that CSE developed in the middle mediastinum, and the other organs were not involved. From an embryologic standpoint, there seemed to be some possible differential diagnoses, such as a pleomorphic carcinoma as a subtype of lung cancer, and CEA as a metastatic mediastinal lymph node cancer of unknown origin or a primary mediastinal lymph node cancer. Like the present case, tumors developed in the middle mediastinum with rapid progression are rare. We report a case, that was difficult to diagnose and treat.
authors.affiliation: Department of Respiratory Diseases, National Hospital Organization Kyushu Medical Center.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Masao
authors.initials: M
authors.lastname: Ichiki
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Taguchi
authors.forename: Syuwa
authors.initials: S
authors.lastname: Minami
authors.forename: Nobue
authors.initials: N
authors.lastname: Imai
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Hisamichi
authors.initials: H
authors.lastname: Aizawa
mesh_terms: D002277:Carcinoma / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D013902:Radiography, Thoracic; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed