[Lung metastases of epithelioid sarcoma revealed by bilateral spontaneous pneumothorax: a pathological diagnosis]

Ann Pathol. 2010 Apr;30(2):139-42. doi: 10.1016/j.annpat.2010.01.004. Epub 2010 Apr 10.
[Article in French]


Spontaneous pneumothorax may be one of the presenting manifestation of metastatic epithelioid sarcoma even if imaging does not show evident metastatic nodules. We report the case of a 24-year-old man presenting a bilateral spontaneous pneumothorax in association with an epithelioid sarcoma developed in the right foot. CT-scan revealed bilateral microcystic lesions with no evidence of metastatic disease. A left thoracoscopy and a pleurodesis were performed. Persistent air leakage led to a thoracotomy during which lung biopsies were carried out. Histopathological examination of the pulmonary biopsies revealed rare millimetric nodules, composed of very atypical epithelioid cells, growing along alveolar walls reminiscent of a bronchiolo-alveolar carcinoma. However, these cells and primary neoplastic cells of the foot tumour were morphologically and immunohistochemically similar and the atypical pulmonary cells were TTF1 negative. All these constatations allowed a diagnosis of pulmonary metastases of the epithelioid sarcoma. This very unusual case underlines that sarcomatous metastases may be a clinical and pathological pitfall.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biomarkers, Tumor / analysis
  • Doxorubicin / administration & dosage
  • Drainage
  • Fatal Outcome
  • Foot Diseases / metabolism
  • Foot Diseases / pathology*
  • Foot Diseases / surgery
  • Humans
  • Ifosfamide / administration & dosage
  • Lung Neoplasms / chemistry
  • Lung Neoplasms / complications
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery
  • Male
  • Neoplasm Proteins / analysis
  • Pleurodesis
  • Pneumothorax / etiology*
  • Sarcoma / chemistry
  • Sarcoma / complications
  • Sarcoma / diagnosis
  • Sarcoma / drug therapy
  • Sarcoma / secondary*
  • Sarcoma / surgery
  • Thoracoscopy
  • Thoracotomy
  • Young Adult


  • Biomarkers, Tumor
  • Neoplasm Proteins
  • Doxorubicin
  • Ifosfamide