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Li G, Zhou H, Jin W, Bai Y. Undifferentiated pleomorphic sarcoma of pancreas: A case report. Asian J Surg 2024:S1015-9584(24)00918-7. [PMID: 38760223 DOI: 10.1016/j.asjsur.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024] Open
Affiliation(s)
- Gen Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650106, China
| | - Hong Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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Patel MH, Guerrero Vinsard D, Agrawal U, Kendziora RW, Siontis BL, Swaroop Vege S, Sweetser S. Primary Pancreatic Undifferentiated Pleomorphic Sarcoma. ACG Case Rep J 2023; 10:e01011. [PMID: 36968124 PMCID: PMC10036072 DOI: 10.14309/crj.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
Primary pancreatic sarcomas are rare malignancies with an incidence of 0.1%. This case report is of a 48-year-old man who presented with this condition. The patient's treatment plan consisted of distal pancreatectomy and splenectomy with intraoperative immunohistochemistry and adjuvant chemotherapy. To correctly identify and treat undifferentiated pleomorphic sarcoma, a stepwise strategy involving cross-sectional imaging and extensive histopathology analysis is necessary.
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Affiliation(s)
| | | | - Upasana Agrawal
- Department of Internal Medicine, Louisiana State University, Shreveport, LA
| | - Ryan W. Kendziora
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Seth Sweetser
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Zhang S, Zhou Z, Xu J. Undifferentiated pleomorphic sarcoma of the lateral thigh with KRAS/NF1 co-mutation recurred after repetitive surgical resection: A case report and review of the literature. Front Surg 2022; 9:842054. [PMID: 36338647 PMCID: PMC9633863 DOI: 10.3389/fsurg.2022.842054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
Undifferentiated pleomorphic sarcoma (UPS), a rare soft tissue sarcoma subtype, mainly occurs in the deep parts of the limbs and trunk, observed as rapidly growing painless lumps, rarely located under the skin or protrudes from the skin surface. The risk of recurrence and metastasis is associated with multiple factors. Mutation of tumor gene, tumor occurrence, location and depth of invasion, and tumor size have great influence on prognosis. In this study, we described a case of UPS with KRAS/NF1 co-mutation. This case had undergone UPS extended resection for four times combined with chemotherapy in another hospital. The resection area was more than 3 cm, and tumor relapsed after all operations. This time, the tumor protruded from the left lateral surface with ulceration and infection. Due to multiple surgeries, the anatomy of the lateral femoral vessels has been seriously damaged. We performed expanded tumor resection and adjacent flap transfer repair; meanwhile, vacuum sealing drainage (VSD)-negative pressure closed the drainage, and the patient recovered well after surgery. After surgery, the patient was transferred to the Department of Oncology for chemotherapy. There was no recurrence after 6 months of follow-up. Gene mutation plays an important role in UPS recurrence and metastasis. At the same time, occurrence and location, depth, and size of UPS have great influence on the prognosis. Deeper exploration and expanded resection are important for the prognosis of UPS.
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Affiliation(s)
- Shuo Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zimo Zhou
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Xu
- Department of Plastic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China,Correspondence: Jing Xu
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Liang Z, Han J, Tuo H, Xue D, Yu H, Peng Y. Undifferentiated pleomorphic sarcoma of the pancreas: a rare case report and literature review. World J Surg Oncol 2022; 20:55. [PMID: 35220968 PMCID: PMC8883712 DOI: 10.1186/s12957-022-02525-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/17/2022] [Indexed: 12/27/2022] Open
Abstract
Background Primary undifferentiated pleomorphic sarcoma (UPS) of the pancreas is an exceedingly rare malignant tumor, with only 15 cases have been reported in the medical literature. At present, clinicians have poor recognition of the tumor, the epidemiology, diagnosis, and treatment of this disease have yet not been established. Case presentation In this report, we depict the clinical and imaging characteristics of a 37-year-old man presenting with a primarily cystic UPS. The patient complained of epigastric pain and distention over 20 days. Abdominal CT and pancreatic magnetic resonance imaging revealed cystic and cystic solid masses in the pancreatic body and tail. An abdominal ultrasound echogram revealed the mass in the body of the pancreas to be cystic with separation echo inside, and the wall was thick, not smooth. Besides, a hypoechoic mass was seen in the tail area of the pancreas with an inhomogeneous echoic pattern, containing small patches of no echo zone in the central. Microscopically, spindle fibroblast-like cells are arranged in a characteristic storiform pattern with pleomorphic and multinucleated cells. Immunohistochemically, tumor cells were positive for CD68 and vimentin. Seven months postoperatively, he was diagnosed with pulmonary lymph node metastasis and died 5 months later. Combined with this case report, we also reviewed the literature regarding UPS of the pancreas. Conclusions As we know, this is the first report on ultrasonography findings of pancreatic UPS. Despite there are no distinctive manifestation of UPS, a solid cystic lesion on ultrasonography or a hypodense area in the lesion on T2-weighted imaging, should be considered for differential diagnosis with pancreatic UPS. We believe this article may add some ideas into the diagnosis and therapy of patients with this tumor.
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Ypsilantis P, Meditskou S, Lambropoulou M, Papamitsou T, Simopoulos C. Spontaneous pancreatic undifferentiated pleomorphic sarcoma in a laboratory rat: A case report. Animal Model Exp Med 2019; 2:222-225. [PMID: 31773099 PMCID: PMC6762044 DOI: 10.1002/ame2.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022] Open
Abstract
We present a case of spontaneous undifferentiated/unclassified sarcoma, of a pleomorphic subtype formerly known as malignant fibrous histiocytoma (UPS/MFH), arising from the pancreas of a laboratory rat. The mass was excised after laparotomy from a 6-month-old female laboratory Wistar rat. It presented a giant multilobulated mass of irregular shape, which had arisen from the pancreas and occupied almost the entire peritoneal cavity. Histologically the tumor was characterized by a highly variable morphological pattern, with frequent transitions from storiform to pleomorphic areas. An extensive immunohistochemical examination revealed no specific lines of differentiation. Immunohistochemical positivity was observed only to MIB-1 (high Ki-67 proliferation index), vimentin and CD68 antibodies. The diagnosis was compatible with UPS/MFH. To the best of our knowledge, the present case is the first report of a spontaneous primary UPS/MFH arising from the pancreas of a laboratory rat.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical ResearchSchool of MedicineDemocritus University of ThraceAlexandroupolisGreece
| | - Soultana Meditskou
- Laboratory of Histology and EmbryologyAristotle University of ThessalonikiThessalonikiGreece
| | - Maria Lambropoulou
- Laboratory of Histology and EmbryologySchool of MedicineDemocritus University of ThraceAlexandroupolisGreece
| | - Theodora Papamitsou
- Laboratory of Histology and EmbryologyAristotle University of ThessalonikiThessalonikiGreece
| | - Constantinos Simopoulos
- Laboratory of Experimental Surgery and Surgical ResearchSchool of MedicineDemocritus University of ThraceAlexandroupolisGreece
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Undifferentiated Pleomorphic Sarcoma of Pancreas: A Case Report and Review of the Literature for the Last Updates. Case Rep Med 2018; 2018:1510759. [PMID: 29955231 PMCID: PMC6000869 DOI: 10.1155/2018/1510759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/21/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022] Open
Abstract
The most prevalent type of soft tissue sarcoma is undifferentiated pleomorphic sarcoma (UPS) or previously known as malignant fibrous histiocytoma. It accounts over 20% of all soft tissue sarcomas and occurs most frequently in the extremities, trunk, and retroperitoneum. However, it has been rarely observed in the digestive system. Pancreas sarcoma represents less than 1% of all pancreatic tumors, and primary UPS of the pancreas is even rarer. It exhibits high recurrence and poor prognosis. In this case, a 72-year-old woman with a UPS tumor which was located in the pancreas head and neck without adhesion to the retroperitoneum will be discussed.
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Manning MA, Paal EE, Srivastava A, Mortele KJ. Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant Potential From the Radiologic Pathology Archives. Radiographics 2018; 38:1047-1072. [PMID: 29787363 DOI: 10.1148/rg.2018170201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Almost all neoplasms of the pancreas are derived from pancreatic epithelial components, including the most common pancreatic mass, primary pancreatic ductal adenocarcinoma (PDAC). Nonepithelial neoplasms comprise only 1%-2% of all pancreatic neoplasms. Although some may arise directly from intrapancreatic elements, many originate from mesenchymal, hematopoietic, or neural elements in the retroperitoneal peripancreatic space and grow into the pancreas. Once these tumors reach a certain size, it can be challenging to identify their origin. Because these manifest at imaging as intrapancreatic masses, awareness of the existence and characteristic features of these nonepithelial neoplasms is crucial for the practicing radiologist in differentiating these tumors from primary epithelial pancreatic tumors, an important distinction given the vastly different management and prognosis. In part 1 of this article, the authors reviewed benign nonepithelial neoplasms of the pancreas. This article focuses on malignant nonepithelial neoplasms and those of uncertain malignant potential that can be seen in the pancreas. The most common malignant or potentially malignant nonepithelial pancreatic tumors are of mesenchymal origin and include soft-tissue sarcomas, solitary fibrous tumor, and inflammatory myofibroblastic tumor. These tumors commonly manifest as large heterogeneous masses, often containing areas of necrosis and hemorrhage. The clinical features associated with these tumors and the imaging characteristics including enhancement patterns and the presence of fat or calcification help distinguish these tumors from PDAC. Hematopoietic tumors, including lymphoma and extramedullary plasmacytoma, can manifest as isolated pancreatic involvement or secondarily involve the pancreas as widespread disease. Hyperenhancing paragangliomas or hypervascular metastatic disease can mimic primary pancreatic neuroendocrine tumors or vascular anomalies.
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Affiliation(s)
- Maria A Manning
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Edina E Paal
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Amogh Srivastava
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Koenraad J Mortele
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
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Qiu LL, Yu RS, Chen Y, Zhang Q. Sarcomas of abdominal organs: computed tomography and magnetic resonance imaging findings. Semin Ultrasound CT MR 2012; 32:405-21. [PMID: 21963162 DOI: 10.1053/j.sult.2011.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sarcomas originating from abdominal organs are extremely rare, and literature in which investigators focus on their imaging features is scarce. This article aims to review the computed tomography and magnetic resonance imaging features of these rare tumors and to help in clinical diagnosis. Various sarcomas (eg, angiosarcoma, undifferentiated embryonal sarcoma, leiomyosarcoma, carcinosarcoma, rhabdomyosarcoma) originating, respectively, from different abdominal visceral organs (liver, pancreas, spleen, kidney, adrenal gland, uterus, and prostate gland) are reviewed along with cases we encountered.
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Affiliation(s)
- Ling-Ling Qiu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Yu RS, Wang JW, Chen Y, Ding WH, Xu XF, Chen LR. A case of primary malignant fibrous histiocytoma of the pancreas: CT and MRI findings. World J Gastroenterol 2008; 14:2942-5. [PMID: 18473429 PMCID: PMC2710746 DOI: 10.3748/wjg.14.2942] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary malignant fibrous histiocytoma (MFH) of the pancreas is rare and a distinct clinical entity. We report a case of recurrence of pancreatic MFH with computed tomography (CT) and magnetic resonance imaging (MRI) findings. A 67-year-old man presented with a history of decreased body weight over the past 6 mo. Abdominal CT revealed a large, multilocular cystic mass in the head of the pancreas with obvious atrophy in the body and tail of the pancreas. After 6 mo postoperatively, MRI demonstrated a recurrent large mass in the primary area of the head of the pancreas. The lesion was heterogeneous, hypointense to the liver on T1-weighted imaging, and heterogeneously hyperintense to the liver with a hypointense area in the central part of the tumor on fat-saturated T2-weighted imaging. Contrast-enhanced T1-weighted imaging demonstrated a large multilocular cystic mass with a cystic wall, fibrous septa and enhancement of solid components. To the best of our knowledge, this is the first report on recurrence of primary MFH of the pancreas, and the first with MRI findings.
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Akatsu T, Shimazu M, Morii T, Morioka H, Yabe H, Kitajima M. Pancreatic metastasis from musculoskeletal sarcoma: a case report with malignant fibrous histiocytoma and review of the literature. Dig Dis Sci 2007; 52:1958-63. [PMID: 17574530 DOI: 10.1007/s10620-006-9424-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Accepted: 05/01/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Tomotaka Akatsu
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
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11
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Laser Literature Watch. Photomed Laser Surg 2006; 24:222-48. [PMID: 16706704 DOI: 10.1089/pho.2006.24.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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