Carcinosarcoma Stomach with Biphasic Nodal Metastasis: A Rare Entity ED04-ED06
Dr. Renu Sukumaran,
Associate Professor, Division of Pathology, Regional Cancer Centre,
Thiruvananthapuram, Kerala, India.
Gastric carcinosarcoma is an extremely rare, aggressive, biphasic tumour composed of a mixture of carcinomatous and sarcomatous elements. Clinical symptoms and imaging studies of carcinosarcoma are not different from that of carcinoma. Biopsy of the lesions may not include both components. Thus, a diagnosis of carcinosarcoma is often rendered in surgical specimens. Immunohistochemistry will help to identify the various components. The relative proportion of the carcinomatous and sarcomatous elements is variable. One of the components may dominate the histologic picture. The common carcinomatous component described is adenocarcinoma with rare cases, showing neuroendocrine and squamous elements. The sarcomatous elements include spindle cell sarcoma which was Not Otherwise Specified (NOS), leiomyosarcoma, fibrosarcoma, osteosarcoma, chondrosarcoma, liposarcoma, undifferentiated sarcoma, myxoid sarcomas, and rhabdomyosarcoma. Herein, the authors are reporting the case of a 62-year-old female patient who presented with abdominal pain and vomiting of three-month duration. Endoscopic examination revealed a large polypoidal mass lesion in the body of stomach. Subtotal gastrectomy was done which showed large polypoidal mass lesion measuring 12×9.5×6 cm. Histopathological examination revealed a biphasic neoplasm with close intermingling of malignant epithelial and mesenchymal elements. Carcinoma component showed glandular, squamous and neuroendocrine areas. The sarcomatous component was spindle cell sarcoma, NOS. On immunohistochemical examination, epithelial component showed cytokeratin positivity. The neuroendocrine component was positive for synaptophysin, chromogranin A and CD56. The p40 positivity noted in the squamous component. The mesenchymal component showed positivity for vimentin. The nodal metastasis showed admixture of carcinoma (glandular and squamous components) and sarcoma.