Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2830-2835
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2830
Postsurgical radiation therapy for gastric carcinosarcoma with c-kit expression: A case report
Takeshi Gohongi, Hiroyuki Iida, Naoto Gunji, Kazuo Orii, Takesaburo Ogata
Takeshi Gohongi, Hiroyuki Iida, Naoto Gunji, Kazuo Orii, Takesaburo Ogata, Department of Surgery and Pathology, Tsukuba-Gakuen Hospital, Ibaraki 305-0857, Japan
Author contributions: Gohongi T and Ogata T designed the report; Ogata T performed the pathologic studies; Gohongi T, Iida H, Gunji N and Orii K performed the surgery and treatment thereafter; and Gohongi T wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takesaburo Ogata, MD, PhD, Department of Surgery and Pathology, Tsukuba-Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba, Ibaraki 305-0857, Japan. gohon@gakuen-hospital.or.jp
Telephone: +81-29-8361355 Fax: +81-29-8361590
Received: August 30, 2014
Peer-review started: August 31, 2014
First decision: September 27, 2014
Revised: November 13, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: March 7, 2015
Processing time: 191 Days and 4.8 Hours
Abstract

Gastric carcinosarcomas are rare morphologically biphasic tumors, consisting of carcinoma and sarcoma components, with a poor clinical course. Here we report the case of a 70-year-old man with advanced Borrmann type III carcinosarcoma arising from the upper body of the stomach with extensive lymph node metastasis who underwent a total, but palliative, gastrectomy. Histology showed the tumor consisted of a biphasic structure of tubular adenocarcinoma and spindle cell sarcoma. Immunohistochemistry revealed sarcoma cells expressing c-kit (CD117) and CD34, which are criteria for gastrointestinal stromal tumors. Nine months after the surgical operation, tumor metastases had extended to the hepatohilar, retroperitoneal and mediastinal lymph nodes. Radiation therapy of 50 Gy markedly decreased the size of each of these nodes and reduced the risk of respiratory complications and jaundice. However, the patient died of respiratory failure due to bronchopneumonia with multiple lung metastases 22 mo after resection. Autopsy revealed severe necrosis in most of the lymph nodes with tumor metastases. Radiation therapy combined with gastrectomy should be considered to improve survival in patients with gastric carcinosarcomas that express c-kit.

Keywords: CD34; C-kit; Gastric carcinosarcoma; Radiation therapy; Gastrointestinal stromal tumor

Core tip: Gastric carcinosarcoma is a rare tumor for which there is no established definitive treatment. We present the first report of gastric carcinosarcoma with c-kit expression treated with neoadjuvant chemotherapy, surgical resection and radiation therapy. Radiation therapy to the metastatic tumors dramatically reduced their size and the patient survived 22 mo after surgery with a good quality of life. Although the relation between c-kit expression and radiation susceptibility remains unknown, this report provides new insight into the treatment of gastric carcinosarcoma for improved prognosis.