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Fenner B, Chaudhury H, Pham M, Tarbox M. Cutaneous carcinosarcoma: a rare diagnosis. Proc AMIA Symp 2023; 36:761-763. [PMID: 37829228 PMCID: PMC10566384 DOI: 10.1080/08998280.2023.2249366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/12/2023] [Indexed: 10/14/2023] Open
Abstract
Carcinosarcoma is a rare malignant tumor that is a combination of carcinoma (cancer of epithelial tissue) and sarcoma (cancer of mesenchymal tissue). In practice, it is more common to have either carcinoma or sarcoma individually, but it is novel to have a combination of the two; as a result, few cases have been reported. Carcinosarcoma typically occurs in visceral organs and is rare in the skin. We present the case of a 68-year-old man with a lesion on his left zygomatic cheek that was revealed to be a biphasic malignant neoplasm. Multiple stains provided evidence of both epithelial and mesenchymal components within the lesion. Treatment for such a diagnosis typically involves a combination of wide local excision or plastic surgery for reconstruction purposes, both of which were used with this patient. This case describes the identification of cutaneous carcinosarcoma using immunohistochemical tests and emphasizes the uniqueness of such a diagnosis that requires early attention and appropriate selective treatment.
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Affiliation(s)
- Blayne Fenner
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA
| | - Hannah Chaudhury
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas, USA
| | - Meredith Pham
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Michelle Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Exenteration and Adjuvant Radiotherapy for Primary Carcinosarcoma of the Anterior Orbit: A Case Report. Ophthalmic Plast Reconstr Surg 2021; 37:e136-e139. [PMID: 33481539 DOI: 10.1097/iop.0000000000001911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carcinosarcoma is a malignant mixed tumor composed of epithelial and mesenchymal components which arises in a variety of tissues, including, in rare cases, the orbit. A 75-year-old male with a history of basal cell carcinoma of the left medial canthus, previously treated with surgical resection and adjuvant radiation therapy, presented with a recurrent 3 cm nodule of the left medial canthus. He underwent surgical resection of the left superior and inferior eyelid with pathology revealing invasive squamous cell carcinoma of upper and lower eyelids with deep orbital tissue involvement and undifferentiated pleomorphic sarcoma involving the dermis and periosteum, consistent with carcinosarcoma. Orbital exenteration was subsequently performed. He successfully underwent adjuvant stereotactic body radiation therapy 30 Gy in 5 fractions with no significant side effects. Follow-up MRI revealed posttreatment changes without evidence of recurrent disease.
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Mijušković Ž, Brašanac D, Rajović M, Sekulović LK. Overgrowth of Undifferentiated Pleomorphic Sarcoma During Vismodegib Treatment of Locally Advanced Basal Cell Carcinosarcoma. JCO Oncol Pract 2020; 16:839-841. [PMID: 32813586 DOI: 10.1200/op.20.00405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Željko Mijušković
- Department of Dermatology and Venereology, School of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Dimitrije Brašanac
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Serbia
| | - Milica Rajović
- Clinic of Plastic Surgery and Burns, School of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Lidija Kandolf Sekulović
- Department of Dermatology and Venereology, School of Medicine, Military Medical Academy, Belgrade, Serbia
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Song EY, Wallace SJ, Sheikh H, Wojcik R, Nayak C. Cutaneous Carcinosarcoma: A Small Case Series and Review of the Literature of a Rare Skin Tumor. Cureus 2020; 12:e9569. [PMID: 32913686 PMCID: PMC7474563 DOI: 10.7759/cureus.9569] [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] [Indexed: 11/18/2022] Open
Abstract
Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this report, we describe two separate cases of carcinosarcoma presenting as nonhealing scalp wounds. Patient A: a 57-year-old male with a nonhealing skin lesion of ten years successfully treated with wide-local excision and local ortichochea flap reconstruction. Patient B: a 75-year-old female that presented with a painless, slow-growing hemorrhagic mass of 7 years invading the skull and dura ultimately requiring craniectomy and free-tissue transfer with anterolateral thigh flap. Cutaneous carcinosarcomas have more favorable outcomes due to low metastatic rates likely due to earlier detection, but delayed presentation can be fatal. Histopathological analysis is critical for determining diagnosis and prognosis. Adequate reconstruction after wide base excision varies and follows the reconstructive ladder/elevator ranging from primary closure up through free-tissue transfer. With cutaneous manifestations of carcinosarcoma seldom reported in the literature, it is our hope that reporting unusual instances such as this will raise awareness and allow for earlier diagnoses, treatments, and reconstructions.
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Affiliation(s)
- Ethan Y Song
- Plastic and Reconstructive Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Sean J Wallace
- Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Hina Sheikh
- Pathology, Health Network Laboratories, Allentown, USA
| | - Randolph Wojcik
- Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Chetan Nayak
- Otolaryngology, Lehigh Valley Health Network, Allentown, USA
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Xu C, Ibbetson J, Yeoh TM, Harries RHC. Aggressive growth of an incompletely excised primary cutaneous basal cell carcinosarcoma on the scalp: a case report. ANZ J Surg 2016; 86:1065-1066. [PMID: 27910277 DOI: 10.1111/ans.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Chris Xu
- Department of Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Jan Ibbetson
- Department of Surgical Pathology, SA Pathology, Adelaide, South Australia, Australia
| | - Tze Ming Yeoh
- Department of Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Richard H C Harries
- Department of Plastic and Reconstructive Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Clark JJ, Bowen AR, Bowen GM, Hyngstrom JR, Hadley ML, Duffy K, Florell SR, Wada DA. Cutaneous carcinosarcoma: a series of six cases and a review of the literature. J Cutan Pathol 2016; 44:34-44. [DOI: 10.1111/cup.12843] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joshua J. Clark
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Anneli R. Bowen
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Glen M. Bowen
- Department of Dermatology; University of Utah; Salt Lake City UT USA
- Department of Dermatology; Huntsman Cancer Institute; Salt Lake City UT USA
| | - John R. Hyngstrom
- Department of Surgery; University of Utah and Huntsman Cancer Institute; Salt Lake City UT USA
| | - Michael L. Hadley
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Keith Duffy
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - Scott R. Florell
- Department of Dermatology; University of Utah; Salt Lake City UT USA
| | - David A. Wada
- Department of Dermatology; University of Utah; Salt Lake City UT USA
- Department of Dermatology; Huntsman Cancer Institute; Salt Lake City UT USA
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A Growing Scalp Nodule. Am J Dermatopathol 2016; 38:466-7. [DOI: 10.1097/dad.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zbacnik AP, Rawal A, Lee B, Werling R, Knapp D, Mesa H. Cutaneous basal cell carcinosarcoma: case report and literature review. J Cutan Pathol 2015; 42:903-10. [DOI: 10.1111/cup.12578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 10/17/2011] [Accepted: 12/15/2011] [Indexed: 12/01/2022]
Affiliation(s)
| | - Ajay Rawal
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
| | - Bailey Lee
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Robert Werling
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Dennis Knapp
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
| | - Hector Mesa
- Department of Pathology; Minneapolis VA Health Care System; Minneapolis MN USA
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Bourgeault E, Alain J, Gagné E. Primary Cutaneous Carcinosarcoma of the Basal Cell Subtype Should Be Treated as a High-Risk Basal Cell Carcinoma. J Cutan Med Surg 2015; 19:407-11. [PMID: 25775619 DOI: 10.1177/1203475415575233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cutaneous carcinosarcoma is a rare primary tumor of the skin, characterized by biphasic epithelial and mesenchymal differentiation. OBJECTIVE Due to the limited number of cases reported, there is no consensus regarding treatment and prognosis. Some authors suggest that cutaneous carcinosarcomas should be viewed as aggressive tumors, with ancillary imaging used to evaluate potential metastatic disease. Other reports demonstrate an indolent disease course, especially with epidermal-type cutaneous carcinosarcomas. METHODS We report a case of cutaneous carcinosarcoma, which we treated with electrodessication and curettage following a shave biopsy. The tumor had an epithelial component resembling a basal cell carcinoma and a fibrosarcomatous stroma. RESULTS At 1-year follow-up, our patient did not show evidence of recurrence or metastasis. CONCLUSIONS Our case suggests that a cutaneous carcinosarcoma with an epithelial component composed of basal cell carcinoma can be regarded as a high-risk nonmelanoma skin cancer.
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Affiliation(s)
| | - Jimmy Alain
- Department of Dermatology, Université Laval, Québec City, Canada
| | - Eric Gagné
- Department of Pathology, Université Laval, Québec City, Canada
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Paniz-Mondolfi A, Singh R, Jour G, Mahmoodi M, Diwan AH, Barkoh BA, Cason R, Huttenbach Y, Benaim G, Galbincea J, Luthra R. Cutaneous carcinosarcoma: further insights into its mutational landscape through massive parallel genome sequencing. Virchows Arch 2014; 465:339-50. [DOI: 10.1007/s00428-014-1628-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/17/2014] [Accepted: 07/02/2014] [Indexed: 01/06/2023]
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An unusual infiltrative basal cell carcinoma with osteoclastic stromal changes mimicking carcinosarcoma: a case report. Am J Dermatopathol 2014; 37:26-30. [PMID: 24786580 DOI: 10.1097/dad.0000000000000131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 91-year-old man presented with an ulcerated nodule on his left lower eyelid. The tumor showed an epithelial component composed of basaloid and clear cells and a stroma that contained many osteoclastic giant cells. Strong, diffuse expression for cytokeratin 17 and p63 was noted in the epithelial component, whereas no staining was present in the sarcomatoid stroma, suggesting that the osteoclast-rich stromal component represented an unusual benign stromal reaction to the carcinoma rather than a manifestation of carcinosarcoma. Further supporting this interpretation was the absence of mitotic figures and low Ki-67 proliferation index (of approximately 1%) in the stromal cells. We herein reported a case of unusual infiltrative basal cell carcinoma, accompanied by a clear cell carcinomatous features and concurrent benign osteoclastic stromal changes.
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Trichoblastic sarcoma with osteosarcomatous differentiation: evolution of one lesion with 3 histologic appearances over a 3-year period. Am J Dermatopathol 2013; 34:658-62. [PMID: 22688391 DOI: 10.1097/dad.0b013e3182491d52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Only one description of trichoblastic sarcoma exists in the literature. Here, we present the first case of trichoblastic sarcoma with heterologous osteosarcomatous differentiation. Biospy 1 demonstrated an intermediate-grade trichoblastic sarcoma with pleomorphic cells and atypical mitotic figures observed only in the stroma. The epithelium contained no malignant cells. The histologic morphology was reminiscent of an intermediate-grade phyllodes tumor of the breast. Biopsy 2, an excisional biopsy taken 7 months later, showed a high-grade sarcoma with osteosarcomatous differentiation. Immunohistochemistry performed on both specimens showed positive CD10 and bcl-2 staining in the sarcomatous component; p63 was positive in the benign epithelium only. p53 was negative in both the benign epithelium and the malignant stroma. Ki-67 labeling was approximately 10% in both components. Specimen 3, a complete rhinectomy performed 3 months later, showed a poorly differentiated sarcoma. Six months following his rhinectomy procedure, multiple pulmonary nodules consistent with metastatic disease were detected on chest computed tomography. This is the first case report documenting the evolution of an intermediate-grade trichoblastic sarcoma to a high-grade lesion with osteosarcomatous differentiation, to a poorly differentiated sarcoma. The tumor morphologically resembles malignant phyllodes tumor of the breast. Our case is the first to show negative p53 and positive bcl-2 staining in a trichoblastic sarcoma. We propose that cutaneous trichoblastic sarcoma is pathogenetically analogous to phyllodes tumors of the breast, adenosarcoma of the uterus, or ameloblastoma of the oral cavity.
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Chou CY, Chen WY, Wang KH, Chen TJ. Carcinosarcoma Derived From Nevus Sebaceus. J Clin Oncol 2011; 29:e719-21. [DOI: 10.1200/jco.2011.35.8093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Che-Yi Chou
- Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Yu Chen
- Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Ting-Jui Chen
- Wan Fang Hospital, Taipei Medical University; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Abstract
A case of a 28 year-old Chinese male who presented with a rapidly growing tumor within a nevus sebaceous on his right cheek. The tumor was excised and immunohistochemical analysis and histology were consistent with spindle-cell squamous cell carcinoma. To the best of our knowledge, it is the first report of cutaneous spindle-cell squamous cell carcinoma developing in nevus sebaceous in the English literature. This report highlights the importance of early excision of any nevus sebaceous with a history of change.
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Affiliation(s)
- Zhou-Wei Wu
- Department of Dermatology, First People's Hospital of Shanghai, Jiaotong University, Shanghai, China
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Upjohn E, Braue A, Ryan A. Primary cutaneous carcinosarcoma: Dermoscopic and immunohistochemical features. Australas J Dermatol 2010; 51:26-8. [DOI: 10.1111/j.1440-0960.2009.00587.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stojsic Z, Brasanac D, Bilanovic D, Mitrovic O, Stevanovic R, Boricic I. Large-cell neuroendocrine carcinoma of the ampulla of Vater. Med Oncol 2009; 27:1144-8. [PMID: 19898974 DOI: 10.1007/s12032-009-9350-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
Large-cell neuroendocrine carcinoma is a high-grade neuroendocrine carcinoma, originally described in the lung. The tumor rarely occurs in extrapulmonary sites like the gastrointestinal tract, and only few examples have been described in the ampulla of Vater. A new case of large-cell neuroendocrine carcinoma of the ampulla of Vater in a 60-year-old man is reported. After pancreatoduodenectomy, macroscopic examination revealed ulcerated tumor in the region of the ampulla of Vater. Microscopically, the tumor exhibited organoid, predominantly nested growth pattern, consisting of large, polygonal cells with pleomorphic nuclei. Average number of mitoses was 36 per 10 high-power fields. Small and large areas of necrosis were identified. Immunohistochemically, the tumor cells were positive for synaptophysin, chromogranin A, PGP 9.5, neuron-specific enolase, pancytokeratin, CK8 and somatostatin and negative for CK7, CK20, S-100, TTF-1, HMB-45, CD117, E-cadherin and regulatory peptides. Ki-67 proliferative index was 41%. Histone deacetylase (HDAC) analysis showed almost identical results for HDAC1, HDAC2 and HDAC3--60, 60.3 and 61%, respectively. Two months after surgery, liver metastases occurred, confirming highly aggressive behavior of large-cell neuroendocrine carcinoma.
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Affiliation(s)
- Z Stojsic
- Institute of Pathology, School of Medicine, University of Belgrade, Dr Subotica 1/II, 11000, Belgrade, Serbia.
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