Sarcomatoid carcinoma of the pancreas: A case report
|
摘要
BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP) is a rare and aggressive epithelial tumor that has both epithelial and mesenchymal features. It is characterized by sarcomatous elements with evidence of epithelial differentiation. And the term"sarcomatoid carcinoma" is often confused with "carcinosarcoma".CASE SUMMARY We present a case of SCP with lymph node metastasis in a 59-year-old male patient. He had experienced darkening of the urine, scleral icterus, and fatigue for 4 weeks. Computed tomography and magnetic resonance imaging revealed a mass in the pancreatic head, and laboratory tests revealed elevated serum bilirubin levels. The patient underwent pancreaticoduodenectomy after biliary decompression. Histologically, spindle cells with marked nuclear atypia and brisk mitotic activity arranged in a storiform or fascicular pattern were present in the bulk of the tumor. Immunohistochemical analysis found that the spindle cells exhibited strong diffuse positivity for epithelial markers, indicative of epithelial differentiation. Accordingly, the pathologic diagnosis of the pancreatic neoplasm was SCP.CONCLUSION Although sarcomatoid carcinomas and carcinosarcomas have different pathologic features, both have epithelial origin.
BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP) is a rare and aggressive epithelial tumor that has both epithelial and mesenchymal features. It is characterized by sarcomatous elements with evidence of epithelial differentiation. And the term"sarcomatoid carcinoma" is often confused with "carcinosarcoma".CASE SUMMARY We present a case of SCP with lymph node metastasis in a 59-year-old male patient. He had experienced darkening of the urine, scleral icterus, and fatigue for 4 weeks. Computed tomography and magnetic resonance imaging revealed a mass in the pancreatic head, and laboratory tests revealed elevated serum bilirubin levels. The patient underwent pancreaticoduodenectomy after biliary decompression. Histologically, spindle cells with marked nuclear atypia and brisk mitotic activity arranged in a storiform or fascicular pattern were present in the bulk of the tumor. Immunohistochemical analysis found that the spindle cells exhibited strong diffuse positivity for epithelial markers, indicative of epithelial differentiation. Accordingly, the pathologic diagnosis of the pancreatic neoplasm was SCP.CONCLUSION Although sarcomatoid carcinomas and carcinosarcomas have different pathologic features, both have epithelial origin.
BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP) is a rare and aggressive epithelial tumor that has both epithelial and mesenchymal features. It is characterized by sarcomatous elements with evidence of epithelial differentiation. And the term"sarcomatoid carcinoma" is often confused with "carcinosarcoma".CASE SUMMARY We present a case of SCP with lymph node metastasis in a 59-year-old male patient. He had experienced darkening of the urine, scleral icterus, and fatigue for 4 weeks. Computed tomography and magnetic resonance imaging revealed a mass in the pancreatic head, and laboratory tests revealed elevated serum bilirubin levels. The patient underwent pancreaticoduodenectomy after biliary decompression. Histologically, spindle cells with marked nuclear atypia and brisk mitotic activity arranged in a storiform or fascicular pattern were present in the bulk of the tumor. Immunohistochemical analysis found that the spindle cells exhibited strong diffuse positivity for epithelial markers, indicative of epithelial differentiation. Accordingly, the pathologic diagnosis of the pancreatic neoplasm was SCP.CONCLUSION Although sarcomatoid carcinomas and carcinosarcomas have different pathologic features, both have epithelial origin.
引文
1 Ruess DA,Kayser C,Neubauer J,Fichtner-Feigl S,Hopt UT,Wittel UA.Carcinosarcoma of the Pancreas:Case Report With Comprehensive Literature Review.Pancreas 2017;46:1225-1233[PMID:28902796DOI:10.1097/MPA.0000000000000904]
2 Lu BC,Wang C,Yu JH,Shen ZH,Yang JH.A huge adenosquamous carcinoma of the pancreas with sarcomatoid change:an unusual case report.World J Gastroenterol 2014;20:16381-16386[PMID:25473201 DOI:10.3748/wjg.v20.i43.16381]
3 Fukushima N,Hruban RH,Kato Y,Klimstra DS,Kl?ppel G,Shimizu M,Terris B,Bosman FT,Carneiro F,Hruban RH,Theise ND.Ductal adenocarcinoma variants and mixed neoplasms of the pancreas.WHOclassification of tumours of the digestive system.4th ed.Bosman FT,Carneiro F,Hruban RH,Theise ND.Lyon:International Agency for Research on Cancer 2010;294-295
4 Rakul NK,Roshni S,Attokaran LL,Rari PM.Sarcomatoid carcinoma of pancreas with liver metastasesA case report with review of literature.J Med Therap 2017;1:1-3[DOI:10.15761/JMT.1000112]
5 Xie Y,Xiang Y,Zhang D,Yao X,Sheng J,Yang Y,Zhang X.Sarcomatoid carcinoma of the pancreas:Acase report and review of the literature.Mol Med Rep 2018;18:4716-4724[PMID:30221744 DOI:10.3892/mmr.2018.9489]
6 Travis WD,Brambilla E,Nicholson AG,Yatabe Y,Austin JHM,Beasley MB,Chirieac LR,Dacic S,Duhig E,Flieder DB,Geisinger K,Hirsch FR,Ishikawa Y,Kerr KM,Noguchi M,Pelosi G,Powell CA,Tsao MS,Wistuba I;WHO Panel.The 2015 World Health Organization Classification of Lung Tumors:Impact of Genetic,Clinical and Radiologic Advances Since the 2004 Classification.J Thorac Oncol 2015;10:1243-1260[PMID:26291008 DOI:10.1097/JTO.0000000000000630]
7 Layfield LJ,Bentz J.Giant-cell containing neoplasms of the pancreas:an aspiration cytology study.Diagn Cytopathol 2008;36:238-244[PMID:18335561 DOI:10.1002/dc.20785]
8 Guarino M,Tricomi P,Giordano F,Cristofori E.Sarcomatoid carcinomas:pathological and histopathogenetic considerations.Pathology 1996;28:298-305[PMID:9007945 DOI:10.1080/00313029600169224]
9 Kane JR,Laskin WB,Matkowskyj KA,Villa C,Yeldandi AV.Sarcomatoid(spindle cell)carcinoma of the pancreas:A case report and review of the literature.Oncol Lett 2014;7:245-249[PMID:24348857DOI:10.3892/ol.2013.1683]
10 Ren CL,Jin P,Han CX,Xiao Q,Wang DR,Shi L,Wang DX,Chen H.Unusual early-stage pancreatic sarcomatoid carcinoma.World J Gastroenterol 2013;19:7820-7824[PMID:24282372 DOI:10.3748/wjg.v19.i43.7820]
11 Shi HY,Xie J,Miao F.Pancreatic carcinosarcoma:first literature report on computed tomography imaging.World J Gastroenterol 2015;21:1357-1361[PMID:25632213 DOI:10.3748/wjg.v21.i4.1357]
12 Giordano G,Berretta R,Silini E.Primary pure spindle cell carcinoma(sarcomatoid carcinoma)of the ovary:A case report with immunohistochemical study.Diagn Pathol 2016;11:70[PMID:27491291 DOI:10.1186/s13000-016-0521-3]
13 Darvishian F,Sullivan J,Teichberg S,Basham K.Carcinosarcoma of the pancreas:a case report and review of the literature.Arch Pathol Lab Med 2002;126:1114-1117[PMID:12204065 DOI:10.1043/0003-9985(2002)1262.0.CO;2]
14 Nakano T,Sonobe H,Usui T,Yamanaka K,Ishizuka T,Nishimura E,Hanazaki K.Immunohistochemistry and K-ras sequence of pancreatic carcinosarcoma.Pathol Int 2008;58:672-677[PMID:18801090 DOI:10.1111/j.1440-1827.2008.02289.x]
15 Pang A,Carbini M,Moreira AL,Maki RG.Carcinosarcomas and Related Cancers:Tumors Caught in the Act of Epithelial-Mesenchymal Transition.J Clin Oncol 2018;36:210-216[PMID:29220296 DOI:10.1200/JCO.2017.74.9523]
16 Shi S,Hua J,Liang C,Meng Q,Liang D,Xu J,Ni Q,Yu X.Proposed Modification of the 8th Edition of the AJCC Staging System for Pancreatic Ductal Adenocarcinoma.Ann Surg 2018[PMID:29334560 DOI:10.1097/SLA.0000000000002668]
2 Lu BC,Wang C,Yu JH,Shen ZH,Yang JH.A huge adenosquamous carcinoma of the pancreas with sarcomatoid change:an unusual case report.World J Gastroenterol 2014;20:16381-16386[PMID:25473201 DOI:10.3748/wjg.v20.i43.16381]
3 Fukushima N,Hruban RH,Kato Y,Klimstra DS,Kl?ppel G,Shimizu M,Terris B,Bosman FT,Carneiro F,Hruban RH,Theise ND.Ductal adenocarcinoma variants and mixed neoplasms of the pancreas.WHOclassification of tumours of the digestive system.4th ed.Bosman FT,Carneiro F,Hruban RH,Theise ND.Lyon:International Agency for Research on Cancer 2010;294-295
4 Rakul NK,Roshni S,Attokaran LL,Rari PM.Sarcomatoid carcinoma of pancreas with liver metastasesA case report with review of literature.J Med Therap 2017;1:1-3[DOI:10.15761/JMT.1000112]
5 Xie Y,Xiang Y,Zhang D,Yao X,Sheng J,Yang Y,Zhang X.Sarcomatoid carcinoma of the pancreas:Acase report and review of the literature.Mol Med Rep 2018;18:4716-4724[PMID:30221744 DOI:10.3892/mmr.2018.9489]
6 Travis WD,Brambilla E,Nicholson AG,Yatabe Y,Austin JHM,Beasley MB,Chirieac LR,Dacic S,Duhig E,Flieder DB,Geisinger K,Hirsch FR,Ishikawa Y,Kerr KM,Noguchi M,Pelosi G,Powell CA,Tsao MS,Wistuba I;WHO Panel.The 2015 World Health Organization Classification of Lung Tumors:Impact of Genetic,Clinical and Radiologic Advances Since the 2004 Classification.J Thorac Oncol 2015;10:1243-1260[PMID:26291008 DOI:10.1097/JTO.0000000000000630]
7 Layfield LJ,Bentz J.Giant-cell containing neoplasms of the pancreas:an aspiration cytology study.Diagn Cytopathol 2008;36:238-244[PMID:18335561 DOI:10.1002/dc.20785]
8 Guarino M,Tricomi P,Giordano F,Cristofori E.Sarcomatoid carcinomas:pathological and histopathogenetic considerations.Pathology 1996;28:298-305[PMID:9007945 DOI:10.1080/00313029600169224]
9 Kane JR,Laskin WB,Matkowskyj KA,Villa C,Yeldandi AV.Sarcomatoid(spindle cell)carcinoma of the pancreas:A case report and review of the literature.Oncol Lett 2014;7:245-249[PMID:24348857DOI:10.3892/ol.2013.1683]
10 Ren CL,Jin P,Han CX,Xiao Q,Wang DR,Shi L,Wang DX,Chen H.Unusual early-stage pancreatic sarcomatoid carcinoma.World J Gastroenterol 2013;19:7820-7824[PMID:24282372 DOI:10.3748/wjg.v19.i43.7820]
11 Shi HY,Xie J,Miao F.Pancreatic carcinosarcoma:first literature report on computed tomography imaging.World J Gastroenterol 2015;21:1357-1361[PMID:25632213 DOI:10.3748/wjg.v21.i4.1357]
12 Giordano G,Berretta R,Silini E.Primary pure spindle cell carcinoma(sarcomatoid carcinoma)of the ovary:A case report with immunohistochemical study.Diagn Pathol 2016;11:70[PMID:27491291 DOI:10.1186/s13000-016-0521-3]
13 Darvishian F,Sullivan J,Teichberg S,Basham K.Carcinosarcoma of the pancreas:a case report and review of the literature.Arch Pathol Lab Med 2002;126:1114-1117[PMID:12204065 DOI:10.1043/0003-9985(2002)1262.0.CO;2]
14 Nakano T,Sonobe H,Usui T,Yamanaka K,Ishizuka T,Nishimura E,Hanazaki K.Immunohistochemistry and K-ras sequence of pancreatic carcinosarcoma.Pathol Int 2008;58:672-677[PMID:18801090 DOI:10.1111/j.1440-1827.2008.02289.x]
15 Pang A,Carbini M,Moreira AL,Maki RG.Carcinosarcomas and Related Cancers:Tumors Caught in the Act of Epithelial-Mesenchymal Transition.J Clin Oncol 2018;36:210-216[PMID:29220296 DOI:10.1200/JCO.2017.74.9523]
16 Shi S,Hua J,Liang C,Meng Q,Liang D,Xu J,Ni Q,Yu X.Proposed Modification of the 8th Edition of the AJCC Staging System for Pancreatic Ductal Adenocarcinoma.Ann Surg 2018[PMID:29334560 DOI:10.1097/SLA.0000000000002668]