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Fleming AM, Hendrick LE, Glazer ES, Murphy AJ, Dickson PV, Shibata D, Yakoub D, Deneve JL. Pancreatic carcinosarcoma: An orthogonal analysis. Surgery 2023; 174:907-915. [PMID: 37524640 DOI: 10.1016/j.surg.2023.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 06/18/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Pancreatic carcinosarcoma is a rare subtype of pancreatic cancer. There are no consensus guidelines regarding its treatment. The current study is an orthogonal analysis of multiple datasets to evaluate prognostic features. METHODS A modified Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 systematic review was performed for reported cases of pancreatic carcinosarcoma. All cases of pancreatic carcinosarcoma in the National Cancer Database were identified for analysis. Analyses were compared to previously published data from the Surveillance, Epidemiology, and End Results database to increase validity. RESULTS Seventy-one cases of pancreatic carcinosarcoma were reported in the literature. Reports of pancreatic carcinosarcoma increased over time (P = .0075). Tumor size >5.0 cm, metastatic disease, and relapse were associated with decreased disease-specific survival (all log-rank P < .05). Ninety-nine cases of pancreatic carcinosarcoma were analyzed within the National Cancer Database. Pancreatic carcinosarcoma incidence increased over time (P = .0371). Resection + chemotherapy, pathologic lymph node examination, and treatment at an academic center were associated with improved overall survival (all log-rank P < .05), whereas harboring ≥2 positive lymph nodes was associated with decreased overall survival (log-rank P = .0171). Within a multivariable model adjusting for age, sex, comorbid disease, and disease stage, resection + chemotherapy was associated with a decreased hazard of death (hazard ratio .036; confidence Interval .004-.298; P = .0022). Published data from the Surveillance, Epidemiology, and End Results database supported the current analysis regarding the incidence of pancreatic carcinosarcoma, resection, lymph node evaluation, and the impact of metastatic disease. CONCLUSION Pancreatic carcinosarcoma is exceedingly rare, with a poor prognosis. Long-term survival is possible with curative resection in the absence of relapse. The number of positive lymph nodes appears to impact prognosis.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
| | - Leah E Hendrick
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN. https://twitter.com/LeahHendrick8
| | - Evan S Glazer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN. https://twitter.com/EvanGlazerMD
| | - Andrew J Murphy
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN. https://twitter.com/ajacksonmurphy
| | - Paxton V Dickson
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN
| | - David Shibata
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN
| | - Danny Yakoub
- Division of Surgical Oncology, Augusta University Medical Center, Augusta, GA
| | - Jeremiah L Deneve
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN. https://twitter.com/jigdeneve
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2
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Qiu H, Hao CY. Neoadjuvant therapy for sarcomatoid carcinoma of the pancreas: a case report and review of the literature. J Med Case Rep 2023; 17:293. [PMID: 37438850 DOI: 10.1186/s13256-023-04006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/25/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas (SCP) is a rare type of malignant pancreatic neoplasm, and its prognosis is even worse than that of conventional pancreatic ductal adenocarcinoma (PDAC). Currently, there is no standard regimen for treating SCP, and the impact of systemic therapy on the survival of patients with SCP has not been well defined. CASE PRESENTATION Herein, we report a 38-year-old Asian man diagnosed of local unresectable SCP with supraclavicular lymph node metastasis, radical excision after camrelizumab and anlotinib therapy, which resulted in a remarkable reduction in the size of primary tumor and complete remission of the metastatic lymph node. CONCLUSIONS This is the first report of the use of immunotherapy and anti-angiogenesis therapy in a patient with SCP, which provides optimistic data to support the synergistic effect.
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Affiliation(s)
- Hui Qiu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China.
| | - Chun-Yi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
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3
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Moreira Marques T, Ribeiro Miranda G, Melo Pinto D, Barbosa L, Faria G. Sarcomatoid Cholangiocarcinoma of the Common Bile Duct: An Unusual Entity. Cureus 2023; 15:e37646. [PMID: 37200651 PMCID: PMC10187943 DOI: 10.7759/cureus.37646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Sarcomatous carcinoma of the bile duct is tremendously uncommon and aggressive. Herein, we report a case of a male who presented with jaundice. The thoraco-abdominopelvic tomography scan revealed a lesion within the common bile duct highly suspicious of malignancy. After laparoscopic pancreaticoduodenectomy, histological examination revealed a sarcomatous carcinoma. Two years after the initial diagnosis, the patient remains without signs of recurrence. Additional research about this rare condition is needed to improve care and prognosis.
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Affiliation(s)
- Tatiana Moreira Marques
- General Surgery Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Gonçalo Ribeiro Miranda
- Pathology Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Diogo Melo Pinto
- General Surgery Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Lilite Barbosa
- General Surgery Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
| | - Gil Faria
- General Surgery Department, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Matosinhos, PRT
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4
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Gkountakos A, Simbolo M, Bariani E, Scarpa A, Luchini C. Undifferentiated Sarcomatoid Carcinoma of the Pancreas: From Histology and Molecular Pathology to Precision Oncology. Int J Mol Sci 2022; 23:1283. [PMID: 35163206 PMCID: PMC8835772 DOI: 10.3390/ijms23031283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 12/12/2022] Open
Abstract
Undifferentiated sarcomatoid carcinoma of the pancreas (SCP) is a rare and aggressive subtype of pancreatic cancer. Histologically, SCP is a poorly differentiated tumor characterized by the lack of glandular differentiation and the presence of mesenchymal-like, spindle-shaped tumor cells. Due to its rarity, only sporadic cases have been reported, while its molecular characterization has not been sufficiently described. Surgical resection with curative intent is the gold-standard of SCP management, but this strategy is possible only in a small proportion of cases due to SCP early metastasization. Although SCP is generally associated with a poor prognosis, some clinical cases amenable to surgical resection and followed by adjuvant chemotherapy have demonstrated a remarkably long survival. Preliminary molecular insights on the SCP molecular landscape have demonstrated the recurrent presence of KRAS and TP53 mutations, highlighting genetic similarities with conventional pancreatic ductal adenocarcinoma (PDAC). Although the use of immunotherapy in PDAC remains an unmet challenge, recent insights indicated a potentially significant role of the PD-L1/Notch3 axis in SCP, opening new horizons for immunotherapy in this cancer subtype. In this review, we described the most important clinic-pathologic features of SCP, with a specific focus on their molecular landscape and the potential targets for precision oncology.
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Affiliation(s)
- Anastasios Gkountakos
- ARC-NET Applied Research on Cancer Center, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.)
| | - Michele Simbolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
| | - Elena Bariani
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
| | - Aldo Scarpa
- ARC-NET Applied Research on Cancer Center, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
| | - Claudio Luchini
- ARC-NET Applied Research on Cancer Center, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
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5
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Toledo PF, Berger Z, Carreño L, Cardenas G, Castillo J, Orellana O. Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature. World J Clin Cases 2021; 9:3716-3725. [PMID: 34046475 PMCID: PMC8130075 DOI: 10.12998/wjcc.v9.i15.3716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/17/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas (SCP) is a rare type of pancreatic neoplasm, and only a few cases have been described in the literature. Histologically, it is composed mostly of atypical spindle cells with apparent sarcomatous features.
CASE SUMMARY This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain. Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy. En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor. Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion. After surgery, the patient did not receive chemotherapy. Previous studies indicate a poor prognosis for this type of malignancy. However, our patient has survived for 35 mo with no recurrence to date.
CONCLUSION The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.
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Affiliation(s)
- Paulina F Toledo
- Department of Gastroenterology, Hospital Clinico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Zoltan Berger
- Department of Internal Medicine, Section Gastroenterology, Hospital Clinico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Laura Carreño
- Department of Pathology, Hospital Clínico de la Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Gonzalo Cardenas
- Department of Radiology, Hospital Clínico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Jaime Castillo
- Department of Surgery, Hospital Clínico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Omar Orellana
- Department of Surgery, Hospital Clínico Universidad de Chile, Santiago 834456, Independencia, Chile
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6
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Kimura T, Togawa T, Iida A, Noriki S, Sato Y, Goi T. Does cellular senescence play an important role in the prognosis of sarcomatoid carcinoma of the pancreas? World J Surg Oncol 2021; 19:79. [PMID: 33726729 PMCID: PMC7968209 DOI: 10.1186/s12957-021-02177-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
Aim Sarcomatoid carcinoma of the pancreas (SCP) is an extremely rare and aggressive disease with poor prognosis. We have already reported a rare case of SCP with long-term survival. In the present article, we investigate the underlying mechanisms of patient’s long-term survival from the point of view of cellular senescence which was examined in three SCP cases, including our reported case, using immunohistochemical analysis. Findings The expressions of cellular senescence marker were observed in the sarcomatous component of the patient with long-term survival but not observed in the other patients with short- term survival. Thus, we can speculate that cellular senescence might play an important role in the reduction of the cell proliferative and metastatic activities of sarcomatous cells, leading to long-term patient survival.
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Affiliation(s)
- Toshihisa Kimura
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan.
| | - Tamotsu Togawa
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Atsushi Iida
- Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Sakon Noriki
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, 4-1-1 Kenjojima, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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7
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Kimura T, Fujimoto D, Togawa T, Ishida M, Iida A, Sato Y, Goi T. Sarcomatoid carcinoma of the pancreas with rare long-term survival: a case report. World J Surg Oncol 2020; 18:105. [PMID: 32450860 PMCID: PMC7249341 DOI: 10.1186/s12957-020-01879-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas (SCP) tends to have similar or even worse prognosis than that of conventional pancreatic ductal adenocarcinoma. The clinical and pathological features of SCP remain poorly characterized owing to its rarity. CASE PRESENTATION A 58-year-old man was admitted to our hospital with the chief complaints of upper abdominal pain and weight loss. Abdominal contrast computed tomography revealed a 5-cm low-density mass in the pancreatic body. Magnetic resonance cholangiopancreatography revealed an obstruction of the main pancreatic duct and a dilation of the distal main pancreatic duct. Based on the clinicoradiological findings, pancreatic body cancer was suspected, and the distal pancreatectomy was performed. A pathological examination revealed that the tumor was composed of an area of invasive ductal adenocarcinoma and an area of sarcomatous spindle-shaped cells; the latter component predominated. The spindle cells were immunohistochemically positive for both cytokeratin and vimentin, and thus, a pathological diagnosis of SCP was made. In addition, immunohistochemical analysis suggested the sarcomatous component might be derived from the adenocarcinoma component via the process of epithelial-mesenchymal transition. After the operation, the patient received 6 months of chemotherapy with gemcitabine. At 10 years after the operation, the patient is alive with no recurrence. CONCLUSIONS The current case study presented a SCP patient with long-term survival after the operation. It was worth noting that the sarcomatous component of the tumor pathologically showed lower MIB-1 labeling index compared with those in previously reported SCP cases, which might account for the long-term survival of the patient.
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Affiliation(s)
- Toshihisa Kimura
- grid.416698.4Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195 Japan
| | - Daisuke Fujimoto
- grid.163577.10000 0001 0692 8246First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193 Japan
| | - Tamotsu Togawa
- grid.416698.4Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195 Japan
| | - Makoto Ishida
- Department of Surgery, Tannan Regional Medical Center, 1-2-31, Saburoku-cho, Sabae, Fukui, 916-8515 Japan
| | - Atsushi Iida
- grid.416698.4Department of Surgery, National Hospital Organization, Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195 Japan
| | - Yasunori Sato
- grid.9707.90000 0001 2308 3329Department of Human Pathology, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Takanori Goi
- grid.163577.10000 0001 0692 8246First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193 Japan
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8
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Zhao S, Su W, Deng L, Chen Y, Zuo C, Shao C, Ren F. Pancreatic sarcomatoid carcinoma: CT, MRI, and 18F-FDG PET/CT features. Clin Radiol 2020; 75:397.e7-397.e14. [PMID: 32044096 DOI: 10.1016/j.crad.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
AIM To investigate computed tomography (CT), magnetic resonance imaging (MRI), and combined 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/CT features of pancreatic sarcomatoid carcinoma (PSC). MATERIALS AND METHODS The hospital database was searched retrospectively for the patients with PSC confirmed at histopathology after surgery. Ten patients who underwent unenhanced and enhanced CT (n=4), unenhanced and enhanced MRI (n=2), 18F-FDG PET/CT (n=2), and both enhanced CT and 18F-FDG PET/CT (n=2) were enrolled. Two patients underwent additional delayed PET/CT. The maximum standardised uptake value (SUVmax) was measured on PET/CT images. RESULTS Eleven lesions were detected in 10 patients. Solid and cystic components (n=6), intratumoural haemorrhage (n=1), nodular calcification (n=2), main pancreatic duct dilatation resulted from lesion obstruction (n=5) or compression (n=3), cholangiectasis (n=5), vascular and peripheral organ invasion (n=5 and 6, respectively), hepatic and lymphatic metastases (n=4 and 2, respectively) were detected. All five lesions in four patients who underwent PET/CT showed intense FDG uptake on PET/CT with SUVmax (16, range 10.9-21.1). Increase of FDG uptake (SUVmax = 18.9, 20.1, and 27.3, respectively) was revealed on the delayed scan of three lesions in two patients. CONCLUSIONS PSCs were more commonly ill-defined solid cystic masses, which caused pancreatic duct obstruction/compression without pancreatic parenchymal atrophy, and these masses on PET/CT showed high FDG uptake on both initial and delayed PET/CT.
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Affiliation(s)
- S Zhao
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - W Su
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - L Deng
- Department of Pathology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Y Chen
- Department of Pathology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - C Zuo
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - C Shao
- Department of Radiology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
| | - F Ren
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
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9
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Zhou DK, Gao BQ, Zhang W, Qian XH, Ying LX, Wang WL. Sarcomatoid carcinoma of the pancreas: A case report. World J Clin Cases 2019; 7:236-241. [PMID: 30705901 PMCID: PMC6354085 DOI: 10.12998/wjcc.v7.i2.236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Dong-Kai Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Bing-Qiang Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wang Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Hui Qian
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li-Xiong Ying
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wei-Lin Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- State Key Laboratory and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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10
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Xie Y, Xiang Y, Zhang D, Yao X, Sheng J, Yang Y, Zhang X. Sarcomatoid carcinoma of the pancreas: A case report and review of the literature. Mol Med Rep 2018; 18:4716-4724. [PMID: 30221744 DOI: 10.3892/mmr.2018.9489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 09/07/2018] [Indexed: 12/15/2022] Open
Abstract
Sarcomatoid carcinoma (SC) is an extremely rare and complicated malignant neoplasm that consists of both malignant epithelial components and atypical spindle cells that express an epithelial phenotype. The presents study reported a case of SC of the pancreas (SCP), along with a brief review of the literature. A 63‑year‑old man was admitted to The Second Hospital of Jilin University hospital with complaints of epigastralgia and jaundice of one month in duration. Based on preoperative laboratory blood tests and radiography, a mass at the distal common bile duct was suspected. Intraoperative examination discovered a 2.5x2x1.8‑cm mass in the pancreatic head, with invasion of the distal bile duct. Pancreaticoduodectomy was performed. Histopathology and immunohistochemistry of the specimen confirmed the diagnosis of SCP. The patient succumbed 18 months after surgery due to multiple hepatic metastases.
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Affiliation(s)
- Yingjun Xie
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Yien Xiang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Dan Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Xiaoxiao Yao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Jiyao Sheng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Yongsheng Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Xuewen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
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11
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Yepuri N, Pruekprasert N, Naous R. High-grade malignant pancreatic neoplasm with sarcomatoid features. AME Case Rep 2018; 2:39. [PMID: 30363708 DOI: 10.21037/acr.2018.08.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/10/2018] [Indexed: 12/26/2022]
Abstract
Sarcomatoid carcinoma is a rare and aggressive form that occur at diverse locations in the body such as upper respiratory tract, upper and lower digestive tracts, genitourinary tract, breast and thyroid glands. However, its occurrence in pancreas has been rarely reported. Sarcomatoid carcinoma of pancreas (SCP) is a high-grade epithelial malignancy composed predominantly of spindle cells often having features suggestive of epithelial derivation without features indicative of a specific line of mesenchymal differentiation. Its pathogenesis has not been elucidated. Microscopically, SCP comprises mostly anaplastic cells and is strikingly sarcoma-like in appearance. Confirmation of this disease is often based on the pathological diagnosis. We report a case that was incidentally found after a CT was done for worsening chronic back pain and the patient was found to have a pancreatic mass and a liver lesion. Endoscopic ultrasound (EUS)-guided liver biopsy revealed high grade malignant pancreatic neoplasm with sarcomatoid features. Further CT chest revealed bilateral lung nodules and PET scan revealed prominent bony metastases within vertebral bodies at L1, L2, and L3. The patient refused definitive treatment and succumbed to illness within 3 months.
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Affiliation(s)
- Natesh Yepuri
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Napat Pruekprasert
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Rana Naous
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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12
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Abstract
Carcinosarcomas are rare biphasic neoplasms with distinct malignant epithelial and mesenchymal components. Most commonly, carcinosarcomas arise in the uterus as malignant mixed müllerian tumors, but also infrequently appear in other organs such as the ovaries and breast, the prostate and urinary tract, the lungs, or in the gastrointestinal system, among others. Pancreatic carcinosarcomas are exceedingly rare; only a few cases are reported in the English literature. Their pathogenesis remains to be fully clarified. We present here the case of a pancreatic carcinosarcoma with evidence for monoclonality via determination of Kras mutational status after microdissection and suggest a common origin of the 2 tumor components. Comprehensive review of the available literature allows the conclusion that most pancreatic carcinosarcomas appear to be of monoclonal origin and seem to have arisen from a carcinoma via metaplastic transformation of 1 part or subclone of the tumor, probably by epithelial-mesenchymal transition. All reported patients were treated with surgery. Adjuvant therapy, if administered, consisted predominantly of gemcitabine. Prognosis for this neoplasm occurs to be similar or even worse compared with classic pancreatic ductal adenocarcinoma. Despite the lack of evidence-based recommendations for its treatment, resection should be performed, if possible.
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13
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Zhang S, Jia J, Bi X, Jiang Q, Zhao Y, Chen Y, Xu Q, Lan Z, Zhang J, Zhang Z, Wang C. Sarcomatoid carcinoma of the common bile duct: A case report. Medicine (Baltimore) 2017; 96:e5751. [PMID: 28099333 PMCID: PMC5279078 DOI: 10.1097/md.0000000000005751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Sarcomatoid carcinoma is an extremely rare lesion in the common bile duct (CBD). PATIENT CONCERNS We present a case of sarcomatoid carcinoma of the distal CBD in a 51-year-old woman who presented with jaundice and abdominal pain. Whipple's operation was performed successfully. Microscopically, the tumor was a poorly differentiated carcinoma containing a component of sarcoma-like differentiation. The tumor cells displayed spindle-shaped nuclei with occasional mitotic figures. Cytokeratin (CK) 7, CK19, CK18, and pan-CK (AE1/AE3) staining was positive on immunohistochemistry. Vimentin and carcinoembryonic antigen (CEA) staining were also positive. DIAGNOSES Sarcomatoid carcinoma of the distal CBD. INTERVENTIONS The patient received three cycles of chemotherapy after surgery. OUTCOMES The patient has experienced no adverse events in the 3 years post-surgery. LESSONS We present here a case report of sarcomatoid carcinoma of the distal CBD. The patient received chemotherapy after surgery, and was event-free for 3 years post-surgery, suggesting a relatively better prognosis, despite the infiltrative pattern of the tumor.
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Affiliation(s)
- Shuisheng Zhang
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jia Jia
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaoning Bi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinglong Jiang
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yajie Zhao
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yingtai Chen
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Quan Xu
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhongmin Lan
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jianwei Zhang
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhihui Zhang
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Chengfeng Wang
- Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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14
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Zhu CC, Li MR, Lin TL, Zhao G. Sarcomatoid carcinoma of the stomach: A case report and literature review. Oncol Lett 2015; 10:1385-1389. [PMID: 26622678 DOI: 10.3892/ol.2015.3460] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 04/30/2015] [Indexed: 12/30/2022] Open
Abstract
Sarcomatoid carcinoma of the stomach is a rare type of malignant tumor, characterized by distinct cellular morphology. This type of tumor is even more rare in giant size. The present study reports a case of giant sarcomatoid carcinoma, which developed in the distal stomach. A 49-year-old male underwent medical investigation for gastrointestinal hemorrhage. Endoscopic examination, computed tomography (CT) and positron emission tomography-CT scan identified a giant neoplasm, which involved the gastric antrum and body, gallbladder and hepatic flexure of the colon. Surgery was performed to excise the tumor, which was ~14×13×8 cm in size. A diagnosis of sarcomatoid carcinoma was made since the tumor was positive for epithelial markers, even within the mesenchymal elements. To the best of our knowledge, only 5 cases of sarcomatoid carcinoma of the stomach have been previously reported, and a tumor that has been able to be resected despite such a large size has never been reported.
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Affiliation(s)
- Chun-Chao Zhu
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Mao-Ran Li
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Tian-Long Lin
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
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15
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Ren C, Chen Y, Han C, Fu D, Chen H. Plasma interleukin-11 (IL-11) levels have diagnostic and prognostic roles in patients with pancreatic cancer. Tumour Biol 2014; 35:11467-72. [PMID: 25123265 DOI: 10.1007/s13277-014-2459-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022] Open
Abstract
Interleukin-11 (IL-11) affects inflammation, motility, and invasion in cancer. Here, we investigated the clinical significance of plasma IL-11 (IL-11p) levels in patients with pancreatic cancer. We enrolled 44 patients with pathologically confirmed diagnoses of pancreatic cancer into this study (median age at diagnosis, 68 years; range, 42-86 years), along with 30 age- and sex-matched healthy controls and 3 patients with pancreatitis complicated with pancreatic cysts and 15 patients with early pancreatitis. Median baseline IL-11p levels of patients with pancreatic cancer were significantly higher than that of the healthy controls (P < 0.001), as were those of the 15 patients with early pancreatitis. IL-11p levels presented high diagnostic accuracy for pancreatic cancer (area under the curve (AUC), 0.901; sensitivity, 97.7%; specificity, 70.0%). Age, sex, lesion site, disease stage, serum dehydrogenase, alkaline phosphatase, γ-glutamyltransferase, and white blood cells, platelets, and hemoglobin levels did not correlate with IL-11p concentrations (P>0.05), but patients with distant metastases had lower median IL-11p values than did patients without distant metastases (P=0.043). Patients with IL-11p higher than the median level (43.2 pg/mL) had better prognoses than those with lower values (P=0.004), particularly as IL-11p concentration increased to ≥ 50 pg/mL (P=0.001). IL-11p concentration correlated with overall survival (≥ median IL-11p, 10 months; <median IL-11p, 4.0 months; P=0.004). In conclusion, IL-11p has diagnostic, predictive, and prognostic applications for patients with pancreatic cancer.
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Affiliation(s)
- Chuanli Ren
- Clinical Medical Testing Laboratory, Northern Jiangsu People's Hospital and Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
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