Early-stage multi-differentiated gastric carcinosarcoma and post-resection local recurrence: a case report

Abstract

Background Carcinosarcoma is a rare neoplasm with a poor prognosis that is most often discovered at an advanced stage; a gastric carcinosarcoma is even rarer than carcinosarcomas originating in other organs, such as the uterus. We report our experience with an early-stage multi-differentiated gastric carcinosarcoma. Case presentation A 68-year-old male patient presented with anemia, and his fecal occult blood test was positive. An endoscopic examination was conducted which revealed a hemorrhagic, irregular, protruding lesion in the stomach. The lesion was diagnosed as an adenocarcinoma by histopathological examination of the biopsy specimen, and a segmental gastrectomy was performed. A 41 × 29 × 18 mm3 protruding lesion was observed in the resection specimen, and histologically confirmed to be a gastric carcinosarcoma with mixed adenocarcinomatous and sarcomatous composition. Tumor invasion was limited to the submucosa. Besides the adenocarcinomatous portion, neuroendocrine differentiation and AFP-positive gastric carcinoma were present in the carcinomatous portion of the tumor; in the sarcomatous portion, chondrosarcomatous, leiomyosarcomatous, and rhabdomyosarcomatous components were observed in addition to the undifferentiated sarcomatous component. Furthermore, the tumor included SALL4-positive germ cell-like cells. Despite early-stage detection, the cancer recurred locally 14 months after tumor resection, which necessitated a total gastrectomy. At the 2-month follow-up after the total gastrectomy, the patient was alive. This patient had developed an esophageal squamous cell carcinoma and primary lung adenosquamous carcinoma, both of which were resected. Conclusions Few cases of early-stage gastric carcinosarcoma have been reported, but there are no reports of recurrence to date. Local recurrence as in this patient, and even in early-stage cases, requires cautious surveillance to check for post-resection recurrence and metastasis. The etiopathogenesis of carcinosarcoma has not yet been elucidated; however, in the present case, despite the tumor’s relatively small size, it exhibited various types of differentiation in both the carcinomatous and sarcomatous components and a proliferative germ cell-like portion, which suggests that the monoclonal origin hypothesis may be a valid theory for the carcinosarcoma.

An Uncommon Presentation of Carcinosarcoma of the Stomach and a Minimally Invasive Approach for Treatment

“…The prognosis for patients with carcinosarcoma remains quite poor, with a mean survival period estimated to be 7–10 months, with 50% of recurrences occurring within the first year postoperatively [ 12 ]. To our knowledge, only 6 cases [ 1 , 4 , 13 – 15 ], including ours, have been diagnosed at an early stage thus far. Interestingly, 4 of the 6 cases showed regional lymph node metastasis, demonstrating the aggressive nature of this tumor.…”

“…Carcinosarcoma is a rare, malignant, and biphasic tumor that has aspects of both carcinoma (a cancer of epithelial tissue) and sarcoma (a cancer of connective tissue). It is often of müllerian origin and arises in the uterus, ovary, and fallopian tube, but it has also been reported to occur in the esophagus, thyroid, lungs, larynx, breasts, and urinary tract [ 1 , 2 ]. While already rare, carcinosarcoma of the gastric mucosa is much rarer, with a literature review citing fewer than 100 reported cases of gastric carcinosarcoma [ 3 ].…”

“…Clinical features of this neoplasm are nonspecific but most commonly include epigastric pain, weight loss, and melena [ 3 ]. The treatment for most patients involves surgical resection by total gastrectomy [ 1 ], while some patients undergo chemotherapy [ 4 ]. Our case was unique in that the patient was treated with a robotic partial gastrectomy, rather than a total gastrectomy.…”

“…Carcinosarcoma is an aggressive and malignant neoplasm composed of both epithelial and mesenchymal components. By the time of diagnosis, the cancer has often metastasized to other organs due to its aggressive nature [ 1 ]. Diagnosing gastric carcinosarcoma promptly and treating the patient appropriately are critical for better outcomes and reducing recurrence.…”

Asymptomatic giant gastric carcinosarcoma

“…Carcinosarcoma is an aggressive malignant tumour composed of epithelial and mesenchymal components. It is usually metastasised to other organs at the time of diagnosis 1. It is frequently referred to as sarcomatoid and spindle cell carcinoma of the stomach.…”