Rapid progression of sarcomatoid carcinoma of the common bile duct

Abstract

Sarcomatoid carcinoma is a rare malignant spindle cell neoplasm in which epithelial differentiation may be demonstrated by immunohistochemical or ultrastructural studies [1,2]. These tumors have been reported in many different organs, including esophagus, lung, liver, stomach, gallbladder, pancreas, small intestine, urinary tract, and uterus. Though well defined, histopathological sarcomatoid carcinoma occurring in the common bile duct (CBD) is extremely rare; and its clinical behavior and prognosis are unclear. Generally, sarcomatoid carcinoma is known to have poorer prognosis than carcinoma. There is a few report where bile duct sarco-matoid carcinoma has better prognosis than in gallbladder carcinoma [3]. We report a case of sarcomatoid carcinoma in the CBD that progressed rapidly after surgery.

Sarcomatoid carcinoma of the common bile duct presenting as painless jaundice

“…Sarcomatoid carcinomas of the CBD are most commonly polypoid in nature (compared with infiltrative). Most cases are located in either the mid or distal CBD, with a minority located in the hilum 13. The underlying pathophysiology is unclear but there are numerous theories as to how they develop including collision, combination, conversion, composition, and the epithelial to mesenchymal transition pathway 11…”

“…Kim et al found that prognosis is variable and can range from 23 days to over 5 years and the survival rates following surgical resection at 1, 2 and 3 years were 53.5%, 35.6% and 35.6%, respectively 13. It is suggested that prognosis is better than gallbladder sarcomatoid carcinomas, since a polypoid growth leads to obstruction and earlier presentation.…”