Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature

Toledo, Paulina F; Berger, Zoltán; Carreño, Laura; Cardenas, Gonzalo; Castillo, Jaime; Orellana, Omar

doi:10.12998/wjcc.v9.i15.3716

Cited by 8 publications

(6 citation statements)

References 33 publications

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“…Multivariate analysis showed that CDS was the only independent prognostic factor of both CSP and SCP, which indicating both diseases were surgical disease. This was in line with the findings that patients could achieved long-term survival after margin-negative surgery with or without adjuvant chemotherapy (22)(23)(24). However, further results from larger prospective studies are needed.…”

Section: Discussionsupporting

confidence: 88%

Comparative study of sarcomatoid carcinoma and carcinosarcoma of the pancreas: a population-based study

Liu¹,

Wang²,

Ying³

2022

Transl Cancer Res TCR

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Background: Sarcomatoid carcinoma (SCP) and carcinosarcoma (CSP) of the pancreas are extremely rare entities and little is known about their characteristics. Using a population-based cancer registry, we aimed at improving our understanding of these entities with a focus on the comparison between these two entities.Methods: Patients with SCP or CSP were identified through the Surveillance Epidemiology and End Results (SEER) database. Demographic and clinical characteristics were collected and compared. Survival was compared using the Kaplan-Meier method and analyzed using the log-rank test and Cox proportional hazards models.Results: A total of 85 patients with SCP and 32 patients with CSP were included in the study. There was no difference in the patient age, race distribution, year of diagnosis, primary site, tumor size, tumor stage, receipt of chemotherapy and receipt of radiotherapy between the two groups. However, more patients with CSP received surgical treatment (P<0.001) when compared to patients with SCP. Overall survival was comparable between the two groups (P=0.562) with a 1-year survival rate of 20.8% and 22.2% for SCP and CSP, respectively. Multivariate analysis showed that surgical resection was independent prognostic factor of both SCP (HR: 0.34, P=0.017) and CSP (HR: 0.17, P=0.017). Chemotherapy was a prognostic factor of CSP in univariate analysis, but not of SCP.Conclusions: SCP and CSP are rare malignant tumors of the pancreas with a dismal prognosis. Surgical resection was the common prognostic factor and was recommended when possible.

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Section: Discussionsupporting

confidence: 88%

Comparative study of sarcomatoid carcinoma and carcinosarcoma of the pancreas: a population-based study

Liu¹,

Wang²,

Ying³

2022

Transl Cancer Res TCR

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“…Sarcomatoid carcinoma (SC) is relatively rare in clinical practice and can occur in multiple organs throughout the body, [6][7][8][9] but the lung and bladder are the most common sites. [10,11] HSC is an uncommon malignancy, accounting for 1.8% of all surgically resected liver malignancies and 3.9-9.4% of autopsy cases.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on the clinical and pathological features of hepatic sarcomatoid carcinoma: Fourteen cases of a rare tumor

et al. 2022

Medicine

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Hepatic sarcomatoid carcinoma is a rare liver malignancy with atypical clinical symptoms and a high degree of malignancy. To improve the understanding of this disease, we collected the clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma admitted to the First Affiliated Hospital and Second Affiliated Hospital of Bengbu Medical College from 2011 to 2021 and reviewed the relevant literature.The clinical and pathological data of 14 patients with hepatic sarcomatoid carcinoma were collected from the electronic medical record system of the 2 hospitals. All clinical data were independently reviewed by 2 clinicians, and all pathological data were independently reviewed by 2 pathologists. At the same time, we reviewed the related literature on hepatic sarcomatoid carcinoma in Pubmed and CNKI.This group of 14 patients, 10 males and 4 females, aged 50-77 years. The main symptoms of the patients were abdominal pain, bloating, anorexia, fatigue or weight loss in the upper abdomen, and 3 patients were asymptomatic. On imaging, hepatic sarcomatoid carcinoma manifests as heterogeneous mass with irregular shape and unclear boundary, and computed tomography (CT)/magnetic resonance imaging (MRI) enhanced scan shows progressive or persistent heterogeneous enhancement, marginal enhancement or annular enhancement, and central necrosis. The pathological features of hepatic sarcomatoid carcinoma are the proliferation of spindle cells and pleomorphic cells, which alternate with acinar cells.Hepatic sarcomatoid carcinoma is more common in middle-aged and elderly patients, especially men, and has no characteristic clinical manifestations. Imaging examination and B-ultrasound-guided liver biopsy + immunohistochemistry can help diagnose. Radical surgery is the preferred method for hepatic sarcomatoid carcinoma, and postoperative adjuvant chemotherapy is expected to prolong patient survival.

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“…A literature search on sarcomatoid carcinoma of the pancreas revealed 16 case reports from 1987 to 2021, only one of which briefly mentions that an FNA was performed prior to surgery and revealed "high-grade malignant epithelial cells." 11,12 In all cases, the histologic description included a combination of spindle cells, pleomorphic multinucleated giant cells, and adenocarcinoma, but none described any specific heterologous elements such as bone formation.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Cytologic, histologic, and molecular features of pancreatic sarcomatoid undifferentiated carcinoma with heterologous osteosarcomatous transformation

Zhang

Sabatino

Castillo

et al. 2023

Diagnostic Cytopathology

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Fine‐needle aspiration (FNA) is a minimally invasive and effective modality to diagnose pancreatic ductal adenocarcinoma. However, some histologic subtypes of ductal adenocarcinoma are rarely encountered and challenging to diagnose on FNA/small biopsies. To date, cytohistologic features of pancreatic sarcomatoid undifferentiated carcinoma with heterologous elements have not been thoroughly described. An 83‐year‐old man with lower back pain was found to have an incidental pancreatic neck mass. FNA biopsy of the mass showed rare markedly atypical, large, pleomorphic cells in a background of abundant calcifications/bone formation without areas of conventional adenocarcinoma. A diagnosis of “Malignant neoplasm with osteosarcomatous differentiation” was rendered on the FNA specimen. Subsequently, a Whipple resection revealed a 4.1 cm lobulated, calcified pancreatic mass. Microscopic examination showed a heavily calcified/ossified mass with adjacent areas of a highly cellular malignant spindle cell proliferation and admixed large, pleomorphic tumor cells; no background conventional adenocarcinoma was identified. Cytokeratin immunostains MNF116 and CK19 were positive in a large subset of the malignant spindle cells, and AE1.3/CAM5.2 showed patchy weak staining. Molecular testing revealed mutations in KRAS, TP53, BRCA2, NTRK3, EPHA2, MYD88, and CBL. No reportable fusions were detected. The final diagnosis was “Sarcomatoid undifferentiated carcinoma with heterologous elements (osteosarcomatous differentiation).” Definitive diagnosis of extremely rare subtypes of ductal adenocarcinoma is challenging on FNA biopsies. In this case, cytologic evaluation was helpful in making an early diagnosis of a malignant neoplasm with highly unusual features, prompting appropriate triage and early surgical resection of a sarcomatoid undifferentiated carcinoma with prominent osteosarcomatous differentiation.

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Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature

Cited by 8 publications

References 33 publications

Comparative study of sarcomatoid carcinoma and carcinosarcoma of the pancreas: a population-based study

Comparative study of sarcomatoid carcinoma and carcinosarcoma of the pancreas: a population-based study

A retrospective study on the clinical and pathological features of hepatic sarcomatoid carcinoma: Fourteen cases of a rare tumor

Cytologic, histologic, and molecular features of pancreatic sarcomatoid undifferentiated carcinoma with heterologous osteosarcomatous transformation

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