Background: Sarcomatoid carcinoma is an unusual form of non-small cell lung cancer (NSCLC) that comprises 0.1% to 0.4% of all pulmonary malignancy. Mean age of onset is around 65 years of age, male to female ratio is almost 4-to-1, and it is associated with a poor prognosis.
Case Report: We present a case of sarcomatoid carcinoma in a 37-year-old patient, with a history of Hodgkin’s lymphoma, treated with chemotherapy, and uncontrolled HIV, initially presenting with unresponsiveness, tachycardia, and hypoxia after several days of vaginal bleeding. Her serum beta-HCG was 93.0 on admission. Her obstetric vaginal ultrasound did not identify an intrauterine pregnancy but did not rule out an ectopic pregnancy. A follow-up Beta-HCG in 1 week showed B-HCG rising to 163. Chest CT on admission revealed a cavitary lesion in the right upper lobe, suspicious for tuberculosis. A lung biopsy performed revealed highly atypical spindle epithelial cells suspicious for sarcomatoid carcinoma. A week later, biopsy of the left iliac bone of a lesion identified on CT scan of the pelvis on admission revealed cells similar in morphology and immunohistochemistry to the lung specimen, consistent with metastatic sarcomatoid carcinoma. After lengthy discussions, the patient opted for hospice care secondary to her poor functional status.
Conclusions: This case highlighted the importance of a broad differential in the approach to patients with unconfirmed diagnosis and expands the metastatic profile of sarcomatoid carcinoma. This is, also to the best of our knowledge, the first case of metastatic sarcomatoid carcinoma in a young female patient and the second in a HIV patients.
