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Lim HJ, Kang HS, Lee JE, Min JH, Shin KS, You SK, Kim KH. Sarcomatoid carcinoma of the pancreas — multimodality imaging findings with serial imaging follow-up: A case report and review of literature. World J Clin Cases 2021; 9:3102-3113. [PMID: 33969097 PMCID: PMC8080743 DOI: 10.12998/wjcc.v9.i13.3102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas is extremely rare and has an extremely poor prognosis. Although a few cases of sarcomatoid carcinoma of pancreas have been reported, most are focused on a histopathological review. To the best of our knowledge, there are no reports documenting multimodality imaging characteristics and chronological changes with emphasis on radiologic features.
CASE SUMMARY A 64-year-old woman was admitted to Chungnam National University Hospital with acute appendicitis. Contrast-enhanced computed tomography of the abdomen revealed a 2.6 cm × 2.8 cm multilobular cystic mass in the pancreatic tail. The pancreatic lesion showed suspected mural nodules and thin septa. Hence, mucinous cystic neoplasm of pancreas was considered. After 7 mo, the patient was readmitted for repeated epigastric abdominal pain and nausea. Follow-up contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging revealed a marked enlargement (5.4 cm × 4 cm), with a predominant internal solid component. The mass showed low signal intensity on a T1-weighted image and heterogeneously intermediate high signal intensity on a T2-weighted image. It showed diffusion restriction and peripheral rim enhancement on an arterial phase image, and progressive enhancement on portal venous and delayed phase images. Distal pancreatectomy was performed. Based on the morphology and immunohistochemical staining of the specimen, pancreatic sarcomatoid carcinoma was diagnosed.
CONCLUSION We present the computed tomography, magnetic resonance imaging, and positron emission tomography computed tomography findings, pathologic features, and chronological changes for preoperative diagnosis.
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Affiliation(s)
- Hyun Jae Lim
- Department of Radiology, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Hye Seon Kang
- Department of Radiology, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Kyung Sook Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 35015, South Korea
| | - Kyung-Hee Kim
- Department of Pathology, Cancer Research Institute, College of Medicine, Chungnam National University, Daejeon 35015, South Korea
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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: 0.6] [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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Saad ESA, Lam JSY, Al-Khan AA, Tayebi M, Day MJ, Richardson SJ, Danks JA. A Comparative Review of Mixed Mammary Tumors in Mammals. J Mammary Gland Biol Neoplasia 2019; 24:125-137. [PMID: 30488318 DOI: 10.1007/s10911-018-9422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 11/21/2018] [Indexed: 11/30/2022] Open
Abstract
Mixed tumors are characterized by the histological identification of two or more cell types. Commonly, a mixture of epithelial and myoepithelial cells is included in abundant stroma, which can consist of myxoid, chondroid or bony matrices. Spontaneously arising mixed tumors are rare lesions in the human breast but are common in human salivary glands and canine mammary glands. Subtle histopathological characteristics and overlapping attributes of malignant lesions with other benign lesions can lead to a diagnostic challenge. Mixed tumors can present as benign or malignant. While malignant mixed tumors are quite rare in the human breast they have a poor prognosis. Benign mixed mammary tumors occur more frequently in female dogs than in humans and are usually associated with a good prognosis. This review will provide a comprehensive overview of mixed mammary tumors, across various mammalian species.
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Affiliation(s)
- Eman S A Saad
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Jacqueline S Y Lam
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- Laverty Pathology, Macquarie Park, Sydney, Australia
| | - Awf A Al-Khan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Mourad Tayebi
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Michael J Day
- School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
| | - Samantha J Richardson
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Janine A Danks
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.
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Still SA, Becerra CR, Clement-Kruzel SE, Cavaness KM. Locally advanced carcinosarcoma of the pancreas. Proc (Bayl Univ Med Cent) 2018; 31:210-212. [PMID: 29706823 DOI: 10.1080/08998280.2018.1444302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 12/27/2022] Open
Abstract
Carcinosarcoma is a rare subtype of pancreatic neoplasm including both carcinomatous and sarcomatous components. Fewer than 30 cases have been reported to the Surveillance, Epidemiology, and End Results Program database. Given such rarity, definitive treatment guidelines are not well defined. We report a case of pancreatic carcinosarcoma diagnosed in our institution, review tumor clinicopathological characteristics, and describe our medical and surgical management strategy.
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Affiliation(s)
- Sasha A Still
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Carlos R Becerra
- Charles A. Sammons Cancer Center, Baylor University Medical Center at Dallas, Dallas, Texas
| | | | - Keith M Cavaness
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas.,Charles A. Sammons Cancer Center, Baylor University Medical Center at Dallas, Dallas, Texas
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Blair AB, Burkhart RA, Griffin JF, Miller JA, Weiss MJ, Cameron JL, Wolfgang CL, He J. Long-term survival after resection of sarcomatoid carcinoma of the pancreas: an updated experience. J Surg Res 2017; 219:238-243. [PMID: 29078888 DOI: 10.1016/j.jss.2017.05.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 04/21/2017] [Accepted: 05/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas (SCP) is a rare histologic subtype of undifferentiated pancreatic carcinoma. Historically, this has been associated with a worse overall prognosis than adenocarcinoma. However, the clinical course and surgical outcomes of SCP remain poorly characterized owing to its rarity. METHODS A single-institution, prospectively maintained database was queried for patients who underwent pancreatic resection with a final diagnosis of SCP. We describe their histology, clinicopathologic features, and perioperative outcomes. Survival data are highlighted, and common traits of long-term survivors are examined. RESULTS Over a 25-year period, 7009 patents underwent pancreatic resection at our institution. Eight (0.11%) were diagnosed with SCP on final histopathology. R0 resection was achieved in six patients (75%). Four patients had early recurrence leading to death (<3 months). Two (25%) experienced long-term survival (>5 years), with the longest surviving nearly 16 years despite the presence of lymph node metastasis. There were no deaths attributed to perioperative complications. Both long-term survivors had disease in the body/tail of the pancreas and received adjuvant radiotherapy. One also received adjuvant gemcitabine-based chemotherapy. CONCLUSIONS SCP is a rarely appreciated subset of pancreatic malignancy that does not necessarily portend to a uniformly dismal prognosis. Although some have rapid recurrence and an early demise, long-term survival may be possible. Future studies are needed to better define the cohort with potential for long-term survival so that aggressive therapies may be tailored appropriately in this patient subset.
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Affiliation(s)
- Alex B Blair
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Richard A Burkhart
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - James F Griffin
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - James A Miller
- The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - John L Cameron
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Christopher L Wolfgang
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jin He
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; The Sidney Kimmel Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; The Sol Goldman Pancreatic Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland.
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Li BQ, Liu QF, Chang XY, Hu Y, Chen J, Guo JC. Pancreatic carcinosarcoma mimics malignant intraductal papillary mucinous neoplasm: A rare case report and literature review. Medicine (Baltimore) 2017; 96:e6961. [PMID: 28591030 PMCID: PMC5466208 DOI: 10.1097/md.0000000000006961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Carcinosarcoma, an extremely rare pancreatic primary tumor, is characterized by coexistence of both carcinomatous and sarcomatous components. Due to its rarity, the clinical manifestation and imaging features have not been recognized. An accurate diagnostic method has not been available and a widely accepted guidelines instructing treatment has not been established. PATIENT CONCERNS We present an uncommon case of pancreatic carcinosarcoma (PCS) which has been preoperatively diagnosed as pancreatic malignant intraductal papillary mucinous neoplasm. A radical resection, including total pancreatectomy (TP) and splenectomy, was performed. DIAGNOSIS The diagnosis of PCS was confirmed by postoperative pathology. INTERVENTIONS A radical resection, including TP and splenectomy, was performed. The patient was followed up by abdominal contrast-enhanced computed tomography scan and blood tumor marker examination. OUTCOMES The patient is still alive and self-sufficient 7 months after the surgery. No evidence of tumor recurrence is found during follow-up. LESSONS Although, until recently, there are no widely accepted guidelines instructing treatment for PCS, a radical resection is still a possible way. All the pancreatic neoplastic patients with high surgical risk should be transferred to a specialized high-volume pancreatic center to get precise preoperative evaluation, fine operation technique, and careful postoperative management.
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Affiliation(s)
| | | | - Xiao-Yan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Hu
- Department of General Surgery
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Jia Z, Zhang K, Huang R, Zhou X, Jiang L. Pancreatic carcinosarcoma with rare long-term survival: Case report and review of the literature. Medicine (Baltimore) 2017; 96:e5966. [PMID: 28121946 PMCID: PMC5287970 DOI: 10.1097/md.0000000000005966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PATIENT CONCERNS We report a rare case of pancreatic carcinosarcoma involving a 44-year-old woman. The patient complained of discomfort associated with the upper abdomen and jaundice of skin and sclera for 1 week. DIAGNOSES After hospitalization, relevant examinations were completed. The disease was diagnosed as carcinoma of the pancreatic head. INTERVENTIONS Whipple procedure was conducted in May 2013. Intraoperative exploration indicated 2 components of the tumor: a fish-shaped gray matter and a hard structure similar to cancellous bone. Histopathological examination showed adenocarcinoma and osteosarcoma. After surgery, the patient received 8 cycles of chemotherapy with gemcitabine and raltitrexed. OUTCOMES Previous studies indicated poor prognosis for pancreatic carcinosarcoma. However, our patient survived for 31 months with no recurrence till date. LESSONS SUBSECTIONS Coexistence of pancreatic adenocarcinoma and osteosarcoma is very rare. Our case was also an exception in manifesting longer survival than expected.
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Affiliation(s)
- Zhe Jia
- Department of General Surgery
| | | | | | - XinGang Zhou
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China
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Kim HS, Kim JI, Jeong M, Seo JH, Kim IK, Cheung DY, Kim TJ, Kang CS. Pancreatic adenocarcinosarcoma of monoclonal origin: A case report. World J Gastroenterol 2014; 20:12682-12686. [PMID: 25253976 PMCID: PMC4168109 DOI: 10.3748/wjg.v20.i35.12682] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/30/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
Adenocarcinosarcoma, a neoplasm containing both carcinomatous and sarcomatous components, is a rare form of a cancer and the pathophysiology is currently poorly understood. Moreover, definitive treatment guidelines for this disease have not yet been established. Pancreatic adenocarcinosarcoma is even more rare and the prognosis is fatal. Here, we report a case of a 77-year-old male with pancreatic adenocarcinosarcoma and metastasis to the liver. The patient presented at our hospital with uncontrolled glucose levels and diabetes mellitus. The patient’s laboratory findings were unremarkable with the exception of elevated carbohydrate antigen 19-9 levels. Biopsies of the tumors in the pancreas and the liver revealed two types of tumors: pancreatic adenocarcinoma and a poorly differentiated sarcoma. To determine if KRAS mutations were present, we performed a peptide nucleic acid (PNA) clamp PCR-based assay. DNA sequencing by PNA clamp PCR identified a point mutation in codon 12 of exon 2 within KRAS from both tumor types. Because the KRAS mutation is observed in both tumor components, our findings support a monoclonal tumor origin followed by subsequent divergent differentiation into the sarcomatous and carcinomatous tumor populations. After we considered the patient’s status and the late stage of tumor detection, gemcitabine chemotherapy was administered.
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