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A carcinosarcoma of the skin in a 74-year-old man is reported. The epithelial element consisted of a highly anaplastic basal cell carcinoma with focal keratinization. The mesenchymal component included elements of fibrosarcoma, chondrosarcoma, osteogenic sarcoma, and synovial sarcoma. This is, to our knowledge, the second reported case of carcinosarcoma arising in the skin.
Carcinosarcoma accounted for 0.27% of nearly 3000 lung cancers examined in this department. All the patients were men aged between 44 and 62 years, and a majority of the tumours occurred in the left lung. Three patients died within six months of lung resection and in each case a postmortem examination was performed. In seven the carcinomatous component was a squamous-celled growth, and in one columnar-celled; the histology of the sarcomatous element varied. Carcinosarcomas form a distinct group of malignant lung tumours. In five cases sarcomatous transformation of the stroma had occurred and was considered to be the usual means by which the mixed type of growth arises. The other three were considered to be "collision" tumours. Carcinomatous metastases without sarcomatous change were seen in lymph nodes in three cases, and in three fatal cases sarcomatous tumour had recurred.
Six cases of carcinosarcoma of the esophagus were studied clinicopathologically, immunohistochemically and with DNA flow cytometry. Transitional areas with morphology intermediate between carcinoma and sarcoma were found microscopically in all cases. Immunohistochemically, the carcinomatous areas contained keratin-positive cell components in all cases while vimentin-positive cells were found in sarcomatous areas in 5 cases. By DNA flow analysis of microdissection, the sarcomatous components of the tumors showed an aneuploid pattern with one exception, in contrast the carcinomatous components were diploid in all cases. In these few cases, PCNA, S-phase fraction and the mitotic rate were extremely high, apparently indicating a correlation with malignant behavior. Accordingly, examination by immunohistochemistry and DNA ploidy is useful for the analysis of biological properties in the so-called carcinosarcoma of the esophagus.
The cellular origin of carcinosarcoma of the bladder is unknown. We addressed this issue by using microsatellite analysis for loss of heterozygosity (LOH) in both the carcinomatous and sarcomatous components of 6 bladder tumors. We tested 40 microsatellite markers from 19 human chromosomes and compared the genetic alterations between the two separately isolated components. The potential relevance of the E-cadherin pathway was also evaluated by immunohistochemistry. All 6 cases revealed identical LOH on chromosomal arms 9p, 9q, 8p, and 8q, corresponding to relatively early events in bladder carcinogenesis. Discordant losses between two alleles in the remaining chromosomes, associated with progression, were seen in all tumors with a trend toward a higher incidence in the more advanced tumors (N1M1 and N1Mx). E-cadherin was strongly expressed in the carcinomatous components (5 of 6), whereas most of sarcomatous elements displayed absence of the protein product (4 of 6). These results indicate that both the carcinomatous and sarcomatous components of carcinosarcoma are derived from a common stem cell. Downregulation of E-cadherin may define one of the pathways responsible for conversion of epithelial cells to the sarcomatous phenotype.
We present a case with gigantic carcinosarcoma (the largest described to date, diameter of 20.5 cm), located in the right upper lobe, in which the discordance between the brief clinical course with limited symptoms and its large size were remarkable. Preoperative diagnosis by bronchial biopsy, as used to be the case in this malignancy, was incorrect (epidermoid), and the define histological characterization was made by thoracotomy. The controversy about pathology, diagnosis and treatment of the carcinosarcoma is discussed.
We describe a case of carcinosarcoma of the lung in a 60-year-old female who was admitted with complaints of productive cough and an abnormal shadow in the chest X-ray. Sputum cytology showed both squamous cell carcinoma and adenocarcinoma cells. Malignant nonepithelial cells were identified in the needle biopsy specimen. Right middle and lower lobectomy was performed to reveal a carcinosarcoma by microscopic and immunohistochemical examination. This case was histologically unusual because it presented multiple carcinomatous elements (squamous cell carcinoma and adenocarcinoma). It was classified as peripheral type according to the clinical classification, showing an extremely poor prognosis. The histogenesis and clinical features of this rare tumor are discussed.
A case of prostatic carcinosarcoma is presented with histopathologic and immunohistochemical characteristics. A 70-year-old man presented with a history of anti-androgen (cyproterone acetate) therapy for prostatic adenocarcinoma. Diffuse and strong staining for progesterone receptor was observed in the carcinosarcoma specimen although it was completely negative in the previous adenocarcinoma specimen. It may be speculated that hormonal therapy might have facilitated the selection of a progesterone-dependent subclone of tumor cells with the ability of mesenchymal differentiation and that genetic instability due to p53 inactivation might have played a role in this process.
A rare case of carcinosarcoma of the ureter is reported. Histologically, this neoplasia was an unusual heterologous carcinosarcoma of the ureter. 2 years after the initial total nephroureterectomy, the patient died from recurrence.
Carcinosarcoma of the prostate is a very rare malignant tumor in men. Only 4 cases have been reported in the English literature. We give herein the 5th case report of carcinosarcoma of the prostate.
True malignant mixed tumor, or carcinosarcoma, of salivary gland origin is rare. Only 19 cases have been reported in the literature and a review of cases seen at the University of Iowa over the last 60 years yielded only two. In one case the mesenchymal component of the tumor contained both osteosarcoma and chondrosarcoma. In the second case, the history and the histology suggest a progression from carcinoma ex pleomorphic adenoma to a carcinosarcoma. These features are documented in this report and literature review.
The clinical case of a 73-year-old man with a history of transitional cell carcinoma of the bladder, an ulcerated mass on the left hemitrigone and left hydronephrosis who underwent radical cystoprostatectomy and urinary diversion followed by cisplatin-gemcitabine chemotherapy is presented. Pathological examination revealed a biphasic mixed tumor characterized by an epithelial and a mesenchymal component. At 24 months of follow-up the patient is alive and free from recurrent disease, with good quality of life and preserved renal function. Carcinosarcoma is highly aggressive and often has a dismal outcome regardless of treatment. Among all the studied prognostic factors, pathological stage is the main predictor of survival. The outcome of our patient suggests that the relatively well tolerated gemcitabine-cisplatin regimen after surgical treatment of invasive carcinosarcoma of the bladder might improve the currently dismal prognosis of selected elderly patients.
A Domestic Shorthaired cat was presented with coughing and severe respiratory distress. Thoracic radiographs revealed a lobar mass and numerous additional cavitated intrapulmonary masses. The cat was euthanized and submitted for necropsy. Histological examination of the large mass revealed 2 distinct neoplastic components consisting of bronchial adenocarcinoma admixed with neoplastic areas composed of highly atypical undifferentiated spindle cells (sarcomatous component). Simultaneous expression of vimentin and cytokeratin by a subpopulation of neoplastic epithelial cells and by rare neoplastic spindle cells was identified. On the basis of histology and immunohistochemical results, a diagnosis of primary pulmonary carcinosarcoma with intrapulmonary epithelial metastases was made. Pulmonary carcinosarcoma is a well-known pathological entity in humans. It is a rare tumor in animals and has not been previously reported in cat.
A 45-year-old woman presented with a short history of abdominal distension and features of intestinal obstruction. Computed tomography examination of the abdomen revealed a solid and cystic mass in the region of the left ovary, but spread within the abdomen was also noted. The ovarian tumor was removed, and an omentectomy was also performed. Microscopic examination of the ovarian tumor and metastases within the omentum showed a carcinosarcoma composed of borderline serous papillary cystadenocarcinoma and angiosarcoma. The angiosarcomatous component was the dominant tumor within the omentum. This case documents an unusual combination of epithelial and sarcomatous elements in an ovarian carcinosarcoma. The tumor behaved aggressively because of the angiosarcomatous component, and since the patient was assessed as having stage IV disease, no further treatment was offered.
An adult male mixed breed dog developed pain, on swallowing, that lasted for 1 week. Physical exam and radiographs revealed a subcutaneous mass in the cervical area and three metastatic nodules in the lung. The cervical mass was surgically removed and fixed in 10% buffered formalin. Histopathologic diagnosis was carcinosarcoma supported by positive immunohistochemistry (IHC) results for cytokeratin and vimentin. IHC for thyroglobulin proved that the tissue of origin was the thyroid gland. This is the fifth canine case of thyroid carcinosarcoma to be documented, but the first one to be confirmed by specific cell markers. It is an extremely rare neoplasm that also occurs in people.
OBJECTIVE: The purpose of this study was to describe the radiologic and pathologic features of pulmonary carcinosarcoma in three patients. CONCLUSION: The tumors measured 9-14 cm in diameter, had inhomogeneous contrast enhancement, and in two cases had invaded the mediastinum or chest wall extensively. Carcinosarcomas are rare tumors that tend to be large, necrotic, enhancing, and locally invasive.
OBJECTIVE: This article describes the MR imaging features of carcinosarcoma of the urinary bladder with clinical presentation and pathologic correlation in three adults. CONCLUSION: Carcinosarcoma of the urinary bladder is a rare and aggressive tumor that has a clinical presentation similar to that of transitional cell carcinoma of the bladder. Dynamic gadolinium-enhanced MR imaging features are discussed.
The patient was a 65-year-old woman with a chief complaint of right upper quadrant pain. Under the diagnosis of gallbladder tumor, preduodenal portal vein and absence of the pancreatic tail, cholecystectomy was performed. Intraoperative findings resulted in a diagnosis of gallbladder tumor, absence of the pancreatic tail, presence of preduodenal portal vein, and malrotation of the intestine. Histological examination of the resected specimens showed a so-called carcinosarcoma. Carcinosarcoma of the gallbladder is a rare tumor of the hepatobiliary region. The present case differs from previously reported cases in its presentation with multiple anomalies including the presence of preduodenal portal vein. Many cases of preduodenal portal vein in an association with duodenal stenosis in children have been reported, but reports of cases of preduodenal portal vein in adult patients are rarely seen in the literature.
Carcinosarcoma of the Müllerian system is an uncommon tumor. We report here a case of extra-uterine carcinosarcoma from pelvic wall, presenting 11 years after hysterectomy. Accidental surgical implantation of endometrioid cells is suggested as the pathogenic mechanism in this case.