The Cost of Lost Follow-Up: A Diagnosis of Sarcomatoid Lung Carcinoma Following a Presumed Benign Pulmonary Mass and the Necessity of a Physician's Suspicion

Pulmonary sarcomatoid carcinoma is a rare non-small cell lung cancer that can rapidly progress and, unfortunately, serves as a diagnostic challenge. In many instances, patients can have non-specific symptoms, and the malignancy itself can produce negative biopsy results, leading to a false sense of security. This is especially true in larger tumors, since surrounding inflammation can obscure malignant tissue. As such, situations like these show the importance of a physician's clinical judgment in guiding management. Here, we would like to discuss a case where an asymptomatic 63-year-old man presented to the emergency department following a fall, but during the traumatic workup, an incidental lung mass was noted. Given the patient's lack of presenting hemoptysis, shortness of breath, unintentional weight loss, etc., with subsequent negative biopsy results, the patient was unconcerned regarding the pulmonary mass. Despite multiple attempts to contact the patient, he was lost to follow-up and returned with severe worsening of his malignancy. Thus, in this case report, we would like to discuss pulmonary sarcomatoid carcinoma, the methods of biopsy results, and the rate of false negatives, as well as highlight the importance of physicians' management and patient follow-up.