Document Type : Review articles

Authors

The Second Department of Hepatobiliary Pancreatology, The First Hospital of Jilin University, Changchun, China

Abstract

Background: Carcinosarcoma is a rare type of malignant tumor that can occur at various organs, such as the digestive tract, lung, and mammary glands (1-4). Carcinosarcoma of the pancreas is an extremely rare and complicated malignant neoplasm, with the characteristics of high invasiveness and rapid progression, early metastasis, and poor prognosis (4).
Case Presentation: We reported a 75-year-old male patient who was admitted with the chief complaint of intermittent pain in the right upper abdomen for more than one month. Computed tomography scans revealed a space-occupying lesion located in the tail of the pancreas considering pancreatic carcinoma. The patient underwent surgical resection of the tumor. Macroscopic observations showed a mass of approximately 6 cm x 5 cm with grayish-white cut surface. Histological analysis showed a large amount of abnormal differentiated epithelial cells and spindle cells. The immunohistochemistry results demonstrated biphasic neoplasm with both malignant epithelial and mesenchymal components. Then, the patient was diagnosed with carcinosarcoma of the pancreas. Although pancreatic carcinosarcoma was considered to have a poor outcome as previously reported, the patient was free of recurrence for 15 months after the surgery, a longer tumor-free survival recorded for this type of cancer, maybe because the patient received gemcitabine adjuvant chemotherapy after the surgery. The current literature shows that the longest postoperative survival time is 26 months (5).
Conclusions: Carcinosarcoma of the pancreas is a rare tumor. Surgery is the main way of treatment, and chemotherapy can delay tumor development to some extent.

Keywords

  1. Zhu CC, Li MR, Lin TL, Zhao G. Sarcomatoid carcinoma of the stomach: A case report and literature review. Oncol Lett. 2015;10(3):1385-9. doi: 10.3892/ol.2015.3460. [PubMed: 26622678]. [PubMed Central: PMC4533308].
  2. Lee SE, Park SY. Sarcomatoid carcinoma of the small intestine: A rare and highly aggressive tumor. J Korean Surg Soc. 2012;83(5):321-4. doi: 10.4174/jkss.2012.83.5.321. [PubMed: 23166892]. [PubMed Central: PMC3491235].
  3. Arshad HS, Dudekula RA, Niazi M, Malik S, Khaja M. A rare case of sarcomatoid carcinoma of the lung with spine metastasis, including a literature review. Am J Case Rep. 2017;18:760-5. doi: 10.12659/ajcr.904584. [PubMed: 28684728]. [PubMed Central: PMC5510997].
  4. Yepuri N, Pruekprasert N, Naous R. High-grade malignant pancreatic neoplasm with sarcomatoid features. AME Case Rep. 2018;2:39. doi: 10.21037/acr.2018.08.02. [PubMed: 30363708]. [PubMed Central: PMC6182016].
  5. Kane JR, Laskin WB, Matkowskyj KA, Villa C, Yeldandi AV. Sarcomatoid (spindle cell) carcinoma of the pancreas: A case report and review of the literature. Oncol Lett. 2014;7(1):245-9. doi: 10.3892/ol.2013.1683. [PubMed: 24348857]. [PubMed Central: PMC3861608].
  6. Higashi M, Takao S, Sato E. Sarcomatoid carcinoma of the pancreas: A case report with immunohistochemical study. Pathol Int. 1999;49(5):453-6. doi: 10.1046/j.1440-1827.1999.00877.x. [PubMed: 10417690].
  7. Darvishian F, Sullivan J, Teichberg S, Basham K. Carcinosarcoma of the pancreas: A case report and review of the literature. Arch Pathol Lab Med. 2002;126(9):1114-7. doi: 10.1043/0003-9985(2002)126<1114:COTP>2.0.CO;2. [PubMed: 12204065].
  8. Barkatullah SA, Deziel DJ, Jakate SM, Kluskens L, Komanduri S. Pancreatic carcinosarcoma with unique triphasic histological pattern. Pancreas. 2005;31(3):291-2. doi: 10.1097/01.mpa.0000178283.96276.8a. [PubMed: 16163064].
  9. Kim HS, Joo SH, Yang DM, Lee SH, Choi SH, Lim SJ. Carcinosarcoma of the pancreas: A unique case with emphasis on metaplastic transformation and the presence of undifferentiated pleomorphic high-grade sarcoma. J Gastrointestin Liver Dis. 2011;20(2):197-200. [PubMed: 21725518].
  10. Bukhari N, Joudeh A. Early stage anaplastic sarcomatoid carcinoma of the pancreas, a case report. Am J Case Rep. 2019;20:597-601. doi: 10.12659/AJCR.915334. [PubMed: 31023997]. [PubMed Central: PMC6501735].
  11. Zhou DK, Gao BQ, Zhang W, Qian XH, Ying LX, Wang WL. Sarcomatoid carcinoma of the pancreas: A case report. World J Clin Cases. 2019;7(2):236-41. doi: 10.12998/wjcc.v7.i2.236. [PubMed: 30705901]. [PubMed Central: PMC6354085].
  12. De la Riva S, Munoz-Navas MA, Betes M, Subtil JC, Carretero C, Sola JJ. Sarcomatoid carcinoma of the pancreas and congenital choledochal cyst. Gastrointest Endosc. 2006;64(6):1005-6. discussion 1006. doi: 10.1016/j.gie.2006.06.004. [PubMed: 17140915].
  13. Yao J, Qian JJ, Zhu CR, Bai DS, Miao Y. Laparoscopic left pancreatectomy for pancreatic sarcomatoid carcinoma: A case report and review of the literature. Oncol Lett. 2013;6(2):568-70. doi: 10.3892/ol.2013.1411. [PubMed: 24137372]. [PubMed Central: PMC3789049].
  14. Zhu WY, Liu TG, Zhu H. Long-term recurrence-free survival in a patient with pancreatic carcinosarcoma: A case report with a literature review. Med Oncol. 2012;29(1):140-3. doi: 10.1007/s12032-010-9804-9. [PubMed: 21264541].
  15. Shen ZL, Wang S, Ye YJ, Wang YL, Sun KK, Yang XD, et al. Carcinosarcoma of pancreas with liver metastasis combined with gastrointestinal stromal tumour of the stomach: Is there a good prognosis with the complete resection? Eur J Cancer Care (Engl). 2010;19(1):118-23. doi: 10.1111/j.1365-2354.2008.00977.x. [PubMed: 19486125].
  16. Ruess DA, Kayser C, Neubauer J, Fichtner-Feigl S, Hopt UT, Wittel UA. Carcinosarcoma of the pancreas: Case report with comprehensive literature review. Pancreas. 2017;46(9):1225-33. doi: 10.1097/MPA.0000000000000904. [PubMed: 28902796].
  17. Wang X, Chen YH, Cai YQ, Liu XB. Undifferentiated (spindle cell) pancreatic carcinoma: A case report with osteochondroid differentiation. JOP. 2015;16(2):209-12. doi: 10.6092/1590-8577/2960. [PubMed: 25791560].
  18. Ergun M, Aydog G, Kayacetin E, Sasmaz N. A case of anaplastic carcinoma of pancreas diagnosed with endoscopic ultrasound-guided fine needle aspiration cytology. Turk J Gastroenterol. 2012;23(6):828-9. doi: 10.4318/tjg.2012.0453. [PubMed: 23864477].
  19. Blair AB, Burkhart RA, Griffin JF, Miller JA, Weiss MJ, Cameron JL, et al. Long-term survival after resection of sarcomatoid carcinoma of the pancreas: An updated experience. J Surg Res. 2017;219:238-43. doi: 10.1016/j.jss.2017.05.065. [PubMed: 29078888]. [PubMed Central: PMC6178816].
  20. Ren CL, Jin P, Han CX, Xiao Q, Wang DR, Shi L, et al. Unusual early-stage pancreatic sarcomatoid carcinoma. World J Gastroenterol. 2013;19(43):7820-4. doi: 10.3748/wjg.v19.i43.7820. [PubMed: 24282372]. [PubMed Central: PMC3837285].