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Carcinosarcoma of the bladder is a rare neoplasm composed of both epithelial and mesenchymal components. We report on a 51-year-old man with vesical carcinosarcoma and seminoma of the testis occurring synchronously.
A mass in the left breast of a 32-year-old woman was first diagnosed as sarcoma with rhabdomyosarcomatous differentiation. Subsequent studies demonstrated a malignant epithelial component to be present, changing the diagnosis to carcinosarcoma. This course of events supports the concept that many, if not all, sarcomas of the breast would be mixed tumors with a malignant epithelial component, if search for the epithelial component was extensive. Carcinosarcomas with rhabdomyosarcomatous differentiation in the breast are rare, but like sarcomas elsewhere, they do not metastasize to regional lymph nodes, but disseminate hematogenously, primarily to the lungs.
Carcinosarcoma of the adrenal gland is an extremely rare variant of adrenocortical carcinoma, characterized by a biphasic pattern of carcinoma and sarcoma-like components. We report a case of adrenal carcinosarcoma occurring in a 61-year-old Korean man who presented with right flank pain of one month duration radiating to the back and right iliac crest. The tumor measured 12 x 12 x 7 cm and adhered to the liver and right upper pole of the kidney. The carcinomatous component of the tumor showed polygonal cells in a broad anastomosing trabecular pattern with delicate slit-like vascular channels; the sarcomatous component showed uniform spindled cells in a fascicular pattern. Both the carcinomatous and sarcomatous portions of the tumor were positive for pan-cytokeratin, and vimentin stained only the sarcomatous areas.
Carcinosarcomas are rare biphasic malignant neoplasms with an epithelial and a spindle cell component. We present a 62-year-old man with a history of noticeably abdominal distension, proved by surgery to be caused by carcinosarcoma of the renal pelvis and urinary bladder, occupying the entire left abdominal flank. We also illustrate the appearance of this rare entity on sonography and computed tomography.
A 60-years old male was admitted to our department for investigation of constipation and hypogastric discomfort intensified during defecation of a few weeks duration. The cause proved to be a rectal carcinosarcoma that was treated by abdominoperineal resection and postoperative chemo-radiotherapy. The patient died 6 months later due to hepatic failure, showing evidence of disseminated disease. In general colonic carcinosarcomas constitute a rare category of malignant neoplasms whose nature is still incompletely understood. No specific treatment guidelines exist. Surgery is the mainstay of treatment and regardless of the addition of adjuvant therapy the prognosis is very poor. Systematic genetic analysis may be the clue for understanding the pathogenesis of these mysterious tumors.
The first case of carcinosarcoma originating from the renal pelvis in Japan is reported. A fifty-five year old woman was admitted to the hospital on July 13, 1987, complaining of a one-year history of lumbago. On physical examination, a mass of child's head size was palpable in the right loin. There were other palpable masses in the posterior head (8 x 8 cm), left anterior chest (3 x 3 cm) and sacral region (3 x 3 cm). A chest X-ray showed multiple pulmonary metastases and an excretory urogram revealed a non-visualizing right kidney. Computed tomogram and renal angiogram suggested right renal tumor. Right renal arterial embolization with ethanol sclerosing was performed. She had previously undergone biopsy of the sacral lesion at another hospital, histological examinations of which pointed to suspected carcinosarcoma. She was treated by a combination chemotherapy with vincristine, adriamycin and cyclophosphamide. Despite one course of chemotherapy, her general condition deteriorated with progression of metastatic lesions in the regions other than the lungs. She died of the disease on december 9, 1987. Autopsy was performed. Sections of the right kidney showed a transitional cell carcinoma in-situ with squamous and glandular differentiation in addition to the chondrosarcoma. The metastases were found in the liver, lung and bone, all of which consisted of chondrosarcoma. On the other hand skin metastases consisted of both carcinomatous and sarcomatous elements. The pathological specimens were reviewed at the Armed Forces Institute of Pathology, Washington, D.C.
We report one case of carcinosarcoma of the prostate in a patient of 43 years old. The clinical symptomatology was dominated by pollakiurie, dysuria digestive disorders, oedema of the lower limbs and the alteration of the general status. Digital rectal examination showed a big prostate, hard and irregular. The rate of PSA increased. Echography revealed a pelvic echogenic mass corresponding to a bulky prostate. CT scan of the abdomen and the pelvis showed a tissular, heterogeneous mass of 11 cm occupying the vesicoprostatic space and invading the basis of the bladder and the adjacent muscles (muscles obturateurs internes). Histology of a biopsy fragment of the mass revealed an adenocarcinoma and a mesenchymatous component calling up a prostatic carcinosarcoma. The treatment consisted in chemotherapy VAC. The evolution was deadly after 2 months.
The MR imaging of an ovarian carcinosarcoma is described. The tumor was heterogeneous and showed very high-intensity on T2-weighted images and iso-intensity on T1-weighted images, with visible enhancement. Even though signal intensities were somewhat different from those of ovarian adenocarcinoma, the preoperative diagnosis of ovarian carcinosarcoma is still difficult.
Choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urinary bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant müllerian mixed tumor) in a 71-year-old woman whose hysterectomy specimen revealed two polypoid lesions of the endometrium, one arising from the anterior endometrium and one arising from the posterior endometrium. Histologic examination revealed three histologic patterns. The anterior endometrial lesion showed a FIGO grade 2 endometrioid endometrial adenocarcinoma. The posterior endometrial lesion showed a carcinosarcoma composed of a high-grade adenocarcinoma and scant homologous stromal sarcoma. In addition, a choriocarcinoma was identified intermixed with the adenocarcinoma. The syncytiocytotrophoblasts and cytotrophoblasts stained strongly with 0 human chorionic gonadotropin (beta-hCG) and human placental lactogen (hPL). The patient's beta-hCG levels on postoperative days 14, 27, and 42 were 283, 32, and 7 mIU/mL, respectively. This unusual case suggests the importance of identifying the choriocarcinomatous component, since the serum beta-hCG can serve as a marker of tumor recurrence postoperatively.
Carcinosarcoma of the urinary bladder is a uncommon tumor with characteristic histopathologic and immunohistochemical findings; his histogenesis have still not been clear; the prognosis seems to be improved by radical cystectomy and adjuvants therapies. We report a case of 47 years old women suffering from suprapubic pains, dysuria and hematuria of five months duration and had a 10 cm suprapubic mass that was found on physical examination. Radiographically, the tumor invaded the dome of the urinary bladder and causes bilateral hydronephrosis. Microscopically it was an urinary bladder carcinosarcoma. Our objective is to discuss the histogenesis, the anatomoclinical and prognosis of these rare tumors.
A 59-year-old woman with leukorrhea. Aspiration smears were obtained from the uterine cavity. The dominant cellular components were fibrogenic sarcomatous cells, which had ill-defined lacy cytoplasm and a single nucleus with finely granular chromatin. There were occasional naked giant cells, and intracytoplasmic eosinophilic granules. Another infrequent cellular component was adenocarcinoma cells. Histopathologically, adenocarcinoma and spindle cell sarcoma were equivalently identified. Twenty-two cases of homologous carcinosarcoma of the uterine corpus were reviewed cytologically in Japan. Cytodiagnosis before treatment was positive for malignancy of carcinosarcoma in 28.6%. Characteristic cytological findings of this case were the presence of flat sheets of atypical cells with broad cytoplasm. These findings suggest epithelial features. However, the finely granular chromatin pattern and smooth nuclear membrane indicate sarcomatous cells.
The association of breast and uterine carcinoma has been demonstrated by many authors. However, these double primaries with endometrial cancer having pathologic features of a carcinosarcoma are a very rare phenomena. Moreover, most of the cases are related to the previous use of tamoxifen for the treatment of breast carcinoma. In the present study we describe a case of an endometrial carcinosarcoma and a synchronous adenocarcinoma of the breast.
We experienced a case of true carcinosarcoma of the esophagus with osteosarcoma. Computed tomography scan revealed calcification of the tumor. Immunohistochemically, vimentin staining was positive, and osteoid formation was found in the sarcomatous portion. It was clear that the lesion contained osteosarcoma of mesenchymal origin, and thus we diagnosed it as true carcinosarcoma.
An 87-year-old man presented with hematuria and dysuria. An endoscopic examination revealed a bladder mucosa which was almost entirely occupied by diverticula. On the left lateral wall of the bladder there was a huge diverticulum which contained a 12 cm mass extending beyond the bladder wall in the extraperitoneal tissues. Upon histological examination the mass proved to be a carcinosarcoma which was composed by a squamous carcinoma and a sarcoma resembling a malignant fibrous histiocytoma. The two components, i.e. carcinomatous and sarcomatous, were separated by a sharp collision border and no intermingling was ever noted. The epithelial component showed immunoreactivity for cytokeratin and EMA, while the mesenchymal component was diffusely reactive for vimentin, alpha-1-antitrypsin and lysozime. Both components were reactive for galectin-3, whereas S100, desmin and smooth muscle actin were negative. This is the fourth reported case of carcinosarcoma originating in a bladder diverticulum.
Carcinosarcoma is a rare laryngeal neoplasm accounting for less than 1% of all malignancies involving this organ. Given its double epithelial, mesenchymal nature, this neoplasm is described in the literature in many ways: sarcomatoid carcinoma, variants of squamous cell carcinoma with fused cells, pseudoscarcoma, pleumorphous carcinoma, polypoid carcinoma, metaplastic carcinoma. Although not invalidating, cytokeratin positive immunohistochemistry is fundamental for diagnosis. Given the different histopathological pictures, the rareness and heterogeneous natural history of such tumors, it is not surprising there is as yet no agreement as to the treatment of choice. An accurate analysis of the literature indicates that both the therapeutic approach and prognosis are the same as those found for normal squamous cell carcinoma. The authors describe a case of laryngeal carcinosarcoma, analyzing the clinical-therapeutic aspects, histopathological features and immunohistochemistry of this rare neoplasm.
We report a case of carcinosarcoma of the renal pelvis and ureter arising in an 89-year-old man who presented at our hospital with gross hematuria. Abdominal computed tomography, excretory pyelography, and retrograde pyelography demonstrated that left hydronephrosis was caused by an ureteral tumor. Left urine cytology indicated transitional cell carcinoma. The patient underwent chemotherapy and radiation therapy. However, gross hematuria recurred, and the patient underwent left nephroureterectomy. The surgical specimen showed carcinosarcoma in the renal pelvis and ureter histologically. He has been free of cancer for 1.5 years.
The last W.H.O classification of odontogenic tumors (1992) individualized a new entity called odontogenic carcinosarcoma. We report a case in which we encountered some difficulties to establish the diagnosis. The patient J.Z., a 26 year-old woman was operated on for a left mandibular tumor corresponding, histologically, to an ameloblastic fibrosarcoma. One year later, we noted a submandibular swelling considered as a local recurrence. After resection, the pathologic examination diagnosed a lymph node metastasis from the same tumor. We decided to observe the patient. Three years post operatively, metastatic lymph nodes appeared, involving a double-component tumor: ameloblastic fibrosarcoma and malignant ameloblastoma. These features allowed the diagnosis of odontogenic carcinosarcoma. We insist on difficulties of the diagnosis and the necessity of radical resection of the tumor with neck dissection.
We report a case of carcinosarcoma of the urinary bladder. A 68-year-old man visited our hospital with complaints of asymptomatic macroscopic hematuria, cold sweat and general malaise. Excretory urography revealed a filling defect in the left wall of the bladder, and subsequent cystoscopy revealed a non-papillary sessile tumor. The tumor was transurethrally resected and its histology showed carcinosarcoma which was characteristics of a mixture of transitional cell carcinoma with spindle cell sarcoma. The patient underwent total cystectomy and his bladder was reconstructed with the ileum. Nevertheless, he died of multiple organ metastases 3 months after the surgery.