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Zhu Z, Liu X, Li W, Wen Z, Ji X, Zhou R, Tuo X, Chen Y, Gong X, Liu G, Zhou Y, Chen S, Song L, Huang J. A rare multiple primary sarcomatoid carcinoma (SCA) of small intestine harboring driver gene mutations: a case report and a literature review. Transl Cancer Res 2021; 10:1150-1161. [PMID: 35116442 PMCID: PMC8798874 DOI: 10.21037/tcr-20-2829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023]
Abstract
Primary sarcomatoid carcinoma (SCA) is a type of rare tumor consisting of both malignant epithelial and mesenchymal components. Only 32 cases of SCA of the small bowel have been reported in the literature to date. Due to its rarity and complexity, this cancer has not been genetically studied and its diagnosis and treatment remain difficult. Here we report a 54-year-old male underwent emergency surgical resection in the small intestine due to severe obstruction and was diagnosed with multiple SCA based on postoperative pathological examination. Over 100 polypoid tumors scattered along his whole jejunum and proximal ileum. Chemotherapy (IFO+Epirubicin) was performed after surgery while the patient died two months after the surgery due to severe malnutrition. Whole-exome sequencing was performed for the tumor tissue with normal tissue as the control. Important cancer-related gene mutations, including KRAS (c.37G>T, p.G13C), TP53 (c.871A>T, p.K291*), EGFR (c.1351C>T, p.R451C), and CDKN2A (c.104_138del, p.G35fs), were found among 286 nonsynonymous somatic mutations (SNV and Indel). Copy-number amplified genes mainly gathered in chromosome 6, 7, 16 and 20. Mutation clustering analysis showed that main genetic abnormalities included DNA methylation, DNA alkylation, cellular homeostasis, and shared similarities with melanoma, glioma, prostate cancer, bladder cancer, non-small cell lung cancer, and pancreatic cancer. In summary, the genomic features of the small intestine SCA were explored at whole-exome level for the first time, and over 200 somatic mutations were identified in the tumor tissue. Key tumor driver gene mutations were revealed, as well as several aberrant functional pathways. These results contribute to further understanding of the pathogenesis and molecular mechanism of this rare tumor.
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Affiliation(s)
- Zhu Zhu
- Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinyi Liu
- HaploX Biotechnology, Shenzhen, China
| | - Wenliang Li
- Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhengqi Wen
- Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiang Ji
- Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruize Zhou
- Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoyu Tuo
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yaru Chen
- HaploX Biotechnology, Shenzhen, China
| | - Xian Gong
- HaploX Biotechnology, Shenzhen, China
| | | | | | | | - Lele Song
- HaploX Biotechnology, Shenzhen, China
| | - Jian Huang
- Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Andrawes PA, Shariff M, Chang Q, Grinberg R. Primary sarcomatoid carcinoma of the small intestine: very rare and aggressive tumour. BMJ Case Rep 2017; 2017:bcr-2016-217895. [PMID: 28077483 DOI: 10.1136/bcr-2016-217895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcomatoid carcinoma of the small intestine is a very rare and aggressive variant of small intestinal cancers with poor prognosis. The tumour primarily affects middle-aged and older patients with a mean age of 57 years at the time of presentation. We report a woman aged 58 years without any relevant medical history who presented with small intestinal obstruction. She underwent radiologic and endoscopy investigation with persistent features of small bowel obstruction. The patient was found to have a small bowel tumour causing the obstruction and underwent surgical excision of the tumour. Pathology revealed malignant neoplasm with sarcomatoid and epithelioid features involving the terminal ileum. The use of immunohistochemical markers helps in wide range of differential diagnoses. Surgical resection is still considered the best and first-line therapy with poor response to chemotherapy and radiotherapy.
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Affiliation(s)
- Peter Abotaga Andrawes
- Department of Surgery, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, Staten Island, New York, USA.,Department of Minimally Invasive Surgery, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, Staten Island, New York, USA
| | - Masood Shariff
- Department of Surgery, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, Staten Island, New York, USA
| | - Qing Chang
- Department of Pathology, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine. Staten Island, New York, USA
| | - Roman Grinberg
- Department of Surgery, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, Staten Island, New York, USA
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Kwok CM. Sarcomatoid carcinoma of the jejunum with gastric metastases: A case report and review of the literature. Int J Surg Case Rep 2016; 28:161-4. [PMID: 27718432 DOI: 10.1016/j.ijscr.2016.09.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/28/2016] [Indexed: 01/31/2023] Open
Abstract
Sarcomatoid carcinoma (SCA) of jejunum is an extremely poor prognostic tumor in human being. The diagnosis of SCA was based on pathological observations and immunohistochemical staining. Surgery is the cornerstones of treatment but the ideal means is still unknown due to the short survival and inadequate reports.
Introduction Sarcomatoid carcinoma (SCA) of jejunum is an extremely rare condition. To our knowledge, only 17 cases have been reported in the literature. Presentation We introduced an additional case of the sarcomatoid carcinoma of jejunum in a 62-year-old Chinese male who presented with epigastric pain for 3 weeks. Multiple tumors originated in the jejunum and metastases to mesentery lymph nodes and distal stomach were found during the laparotomy. The patient underwent palliative resection of the tumors. He died 11 days after the operation. Discussion Sarcomatoid carcinoma (SCA) of jejunum is an extremely poor prognostic tumor in human being. The diagnosis of SCA was based on pathological observations and immunohistochemical staining. There is no official treatment guideline for SCA, but wide excision including the tumor is the main goal of treatment. Conclusion This is the first case of sarcomatoid carcinoma of jejunum with gastric metastases being reported and also the shortest survival period after the operation. Surgery is the cornerstones of treatment but the ideal means is still unknown due to the short survival and inadequate reports.
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Zhang B, Cheng BO, Wang L, Zhao KE, Zhuo GZ, Ding JH. Primary sarcomatoid carcinoma of the jejunum with massive intra-abdominal hemorrhage: A case report and review of the literature. Mol Clin Oncol 2016; 4:811-816. [PMID: 27123285 DOI: 10.3892/mco.2016.809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/25/2016] [Indexed: 12/22/2022] Open
Abstract
Primary sarcomatoid carcinoma of the jejunum is an extremely rare condition, with only 16 cases reported in the literature to date. We herein report an additional case of a giant sarcomatoid carcinoma of the jejunum in a 62-year-old male patient, presenting as massive intra-abdominal hemorrhage. During emergency laparotomy, ~5 litres of bloody ascites was found in the peritoneal cavity and the tumor was located in the proximal jejunum. The tumor involved the entire wall of the jejunum and had directly invaded the neighboring parietal peritoneum, omentum, transverse colon and mesentery, with metastatic lymph nodes. The patient underwent palliative resection of the tumor; however, the course was rapidly progressive and he succumbed to progression of abdominal and liver metastases 4 weeks after surgery. The tumor was found to be positive for epithelial and mesenchymal markers on immunohistochemical analysis. This case emphasizes the aggressive clinical course and metastatic nature of this malignant tumor, with a supplementary review of the previously published literature.
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Affiliation(s)
- Bin Zhang
- Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, Beijing 100088, P.R. China
| | - B O Cheng
- Department of Clinical Pathology, The General Hospital of the PLA Rocket Force, Beijing 100088, P.R. China
| | - Linxiong Wang
- Cancer Center Lab, Chinese People's Liberation Army General Hospital & Beijing Key Laboratory of Cell Engineering & Antibody, Beijing 100853, P.R. China
| | - K E Zhao
- Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, Beijing 100088, P.R. China
| | - Guang-Zuan Zhuo
- Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, Beijing 100088, P.R. China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, Beijing 100088, P.R. China
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Lee SE, Park SY. Sarcomatoid carcinoma of the small intestine: a rare and highly aggressive tumor. J Korean Surg Soc 2012; 83:321-4. [PMID: 23166892 PMCID: PMC3491235 DOI: 10.4174/jkss.2012.83.5.321] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/29/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
Abstract
Sarcomatoid carcinoma of the small intestine is an extremely rare malignant neoplasm that usually has a poor prognosis. We report a case of sarcomatoid carcinoma arising in the small intestine in a 62-year-old man who was hospitalized for abdominal pain. Computed tomography revealed wall thickening of the small intestine. The resected specimen showed a gray-whitish solid mass with hemorrhage and necrosis. Microscopically, the tumor was composed of pleomorphic spindle and discohesive polygonal cells with frequent mitosis. No carcinomatous component was recognized. Immunohistochemistry revealed coexpression of cytokeratin and vimentin by the tumor cells, whereas expressions of C-kit, CD34, HMB-45, smooth muscle actin, and desmin were negative. The diagnosis was sarcomatoid carcinoma of the small intestine.
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Affiliation(s)
- Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
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Sourianarayanane A, Bauer TW, Sanaka MR, Rizk M. Duodenal obstruction and bleeding caused by metastatic müllerian adenosarcoma. Gastrointest Endosc 2011; 73:176-7. [PMID: 20630522 DOI: 10.1016/j.gie.2010.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/29/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Achuthan Sourianarayanane
- Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
AIM: Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual.
METHODS: Formalin-fixed, paraffin-embedded tissues were cut into 5 μm thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117.
RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine.
CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.
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Affiliation(s)
- Davor Tomas
- Ljudevit Jurak University Department of Pathology, Sestre milosrdnice University Hospital Vinogradska 29, 10000 Zagreb, Croatia
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Abstract
Sarcomatoid carcinoma of the small bowel is rare; to our knowledge, 19 cases have been reported to date in the English literature under several names. We report an additional case occurring in the jejunum of a 55-year-old man. The tumor was a polypoid 7.5-cm mass, which infiltrated the full thickness of the intestinal wall and the serosa of an adhesed loop of small bowel. On microscopic examination, the neoplasm was composed of sheets of spindle cells; focally, an anaplastic component was present, including tumor giant cells with bizarre nuclei. On immunohistochemical stains, tumor cells were positive for cytokeratin 7, cytokeratin AE1/AE3, vimentin, and focally, epithelial membrane antigen. No staining for cytokeratin 20 was found. Sarcomatoid carcinoma must be kept in mind in the differential diagnosis of malignant spindle cell tumors of the small bowel. As consensus regarding the terminology of these rare tumors is being reached, immunohistochemical stains are essential for accurate diagnosis.
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Affiliation(s)
- Michelle Reid-Nicholson
- Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, USA
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