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A 58-year-old woman underwent a curative total abdominal hysterectomy with bilateral salpingo-oophorectomy for a uterine carcinosarcoma. Fifteen months later, PET and CT scan revealed three pulmonary nodules and multiple lymphadenopathy. An atypical lung segmentectomy with dissection of the regional lymph nodes was performed. Two of the three nodules showed morphological and immunohistochemical profiles consistent with the diagnosis of large-cell neuroendocrine carcinoma (LCNEC). The third nodule, the surrounding pulmonary parenchyma and lymph nodes showed diffuse sarcoid granulomatosis. Re-review of the histology of the uterine carcinosarcoma revealed LCNEC morphology with immunohistochemical and genetic profiles identical to the lung cancers, finally deemed as metastatic deposits. Systemic sarcoidosis was ruled out. To our knowledge this is the first case of uterine carcinosarcoma with LCNEC features metastatic to the lung and occurring in association with sarcoid reaction.

Synchronous triple lung tumours are rare and little is known as for their genetic basis. Here we report a case of a 59 years old male with three synchronous independent and histological different primary tumours of the left lung. Two nodules were located in the upper lobe and consisted of an adenocarcinoma (ADC) and an endobronchial poorly differentiated squamous cell carcinoma (SCC). A third nodule of the lower lobe corresponded to a small cell neuroendocrine carcinoma (SCLC). To assess if they represented independent primary tumours and have common genetic profiles, tumours were investigated for loss of heterozygosity (LOH) at 40 chromosomal markers. A comparable fractional allelic loss of 0.52 was observed in the ADC and SCLC, while it was 0.28 in the SCC. Microallelotyping analysis did not reveal a common genetic profile, supporting the hypothesis that the three synchronous tumours are truly independent primaries with different histogenesis.