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Souza DLS, Kelley SR. Colorectal Sarcomatoid Carcinoma: 30-Year Experience. Am Surg 2024:31348241256073. [PMID: 38767188 DOI: 10.1177/00031348241256073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background: Primary colorectal sarcomatoid carcinoma is a rare and aggressive malignant neoplasm that displays mixed epithelial and mesenchymal differentiation, with uncertain histogenesis. First described in 1986, there is a paucity of literature related to this condition and there are no evidence-based treatment guidelines. The aim of our study is to present our 30-year experience with primary colorectal sarcomatoid carcinoma. Methods: Retrospective single-center analysis of all patients treated for primary colorectal sarcomatoid carcinoma from 1992 to 2022. The primary outcome was response to treatment strategy and overall survival. Results: A total of six cases met eligibility criteria. Three were male (50%) with a mean age at diagnosis of 59 years (range, 49-72). Four neoplasms were located in the rectum (66%) and two in the colon. Mean tumor size at diagnosis was 4.8 cm (range, 2.8-7.0). Three patients were treated endoscopically and three underwent oncologic surgical resection. Five experienced recurrence and one expired from other comorbidities. The mean survival among those with colonic and rectal sarcomatoid carcinoma was 7 months (range, 3-11) and 39 months (range, 9-60), respectively. Discussion: Primary colorectal sarcomatoid carcinoma is a rare malignant tumor with poor prognosis. Treatment modalities have not been standardized and despite multimodal therapy, disease recurrence and/or metastasis is likely to occur. Further studies are necessary to determine optimal treatment to improve outcomes.
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Affiliation(s)
- Dante L S Souza
- Department of Surgery, TriHealth Good Samaritan Hospital, Cincinnati, OH, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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Golconda U, McHugh KE, Allende DS, Collins K, Henn P, Lacambra M, Bejarano PA, Groisman GM, Loughrey MB, Monappa V, Zhang X, Hornick JL, Gonzalez RS. Colorectal Carcinoma With Sarcomatoid Components: Report of 15 Cases and Literature Review of an Exceedingly Rare Carcinoma Subtype. Am J Surg Pathol 2024; 48:465-474. [PMID: 38155543 DOI: 10.1097/pas.0000000000002172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Colorectal carcinoma with sarcomatoid components (which includes so-called carcinosarcomas and sarcomatoid carcinomas) is a rare subtype with 50 reported cases in the literature and overlapping criteria with undifferentiated carcinoma. We collected and described 15 cases from 10 men and 5 women, with a mean age of 66 years. Symptoms included abdominal pain and gastrointestinal bleeding. Most tumors presented in the rectosigmoid region, with a mean size of 8.2 cm. The sarcomatoid component, on average, represented 58% of the tumors and took many forms, including spindled (10 cases), anaplastic (9 cases), and rhabdoid (3 cases); one case showed osteoid matrix. Tumor budding was usually high, and tumor-infiltrating lymphocytes were usually low. The sarcomatoid component was keratin-positive in 10 cases. One case showed loss of mismatch repair protein expression, and 2 cases showed SMARCA4 loss (1 also with SMARCA2 loss). Molecular testing identified mutations in KRAS (n=1), NRAS (n=2), BRAF (n=2), APC (n=1), and TP53 (n=1) in a few cases. Tumors often presented at advanced stage, with 11 cases pT4, 9 cases with nodal metastases, and 7 cases with distant metastases. Follow-up was available for 10 cases (median: 2 months), with 2 alive without disease, 3 alive with disease, and 5 dead. Our findings roughly corresponded with those in previously reported cases. Colorectal carcinoma with sarcomatoid components is rare and aggressive, with a poor prognosis for many patients. We suggest that spindled cells, anaplasia, heterologous elements, and/or a component with definable sarcomatous lineage be used to distinguish colorectal carcinoma with sarcomatoid components from undifferentiated carcinoma.
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Affiliation(s)
| | - Kelsey E McHugh
- Department of Pathology, The Mayo Clinic Arizona, Phoenix, AZ
| | | | - Katrina Collins
- Department of Clinical Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN
| | - Patrick Henn
- Department of Pathology, University of Colorado, Aurora, CO
| | - Maribel Lacambra
- Department of Anatomical and Cellular Pathology, The Chinese University ofHongKong, HongKong, China
| | | | | | - Maurice B Loughrey
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Vidya Monappa
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
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Todori M, Yanagawa N, Ito K, Ito Y, Suzuki M, Sugimoto R, Osakabe M, Uesugi N, Sugai T. Rectal Carcinoma With a Sarcomatoid Component: A Case Report With Detailed Immunohistochemistry, Molecular Analysis, and Literature Review. Int J Surg Pathol 2023; 31:1548-1552. [PMID: 36890707 DOI: 10.1177/10668969231160253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Introduction. Carcinoma with sarcomatoid components is a highly malignant tumor exhibiting both epithelial and stromal malignant differentiation. Its tumorigenesis is associated with epithelial-mesenchymal transition (EMT), and phenotypic changes from carcinoma to sarcoma are associated with TP53 mutations. Case presentation. A 73-year-old female with bloody stool was diagnosed with rectal adenocarcinoma. She underwent trans-anal mucosal resection. Histopathologically, the tumor cells showed 2 morphologically distinct populations. One was composed of well-formed to fused glands or cribriform glands and was considered a moderately differentiated adenocarcinoma. The other consisted of pleomorphic discohesive atypical tumor cells with spindle and/or giant cell features, which was considered a sarcomatous tumor. Immunohistochemistry analysis showed that E-cadherin expression changed from positive to negative in the sarcomatous component. On the other hand, ZEB1 and SLUG were positive. Finally, she was diagnosed with carcinoma with a sarcomatoid component. We performed a mutation analysis by next genome sequencing and found KRAS and TP53 mutations in both carcinomatous and sarcomatous components. Conclusions. Immunohistochemistry and mutation analyses revealed tumorigenesis of rectal carcinoma with sarcomatoid components correlated with EMT and TP53 mutations.
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Affiliation(s)
- Mikiya Todori
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Naoki Yanagawa
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Kazuhiro Ito
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Yuma Ito
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Masamichi Suzuki
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Ryo Sugimoto
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Mitsumasa Osakabe
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Yahaba-cho, Japan
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Park CL, Rajadurai CV, Ton Nu TN, Mandilaras V. An Unconventional Regimen of Carboplatin and Paclitaxel in Metastatic Colorectal Carcinosarcoma: A Case Report and Review of Literature. Curr Oncol 2023; 30:4897-4903. [PMID: 37232827 DOI: 10.3390/curroncol30050369] [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: 04/10/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
Colorectal carcinosarcoma is an exceedingly rare subtype of colorectal cancer that displays the histological and molecular features of both mesenchymal and epithelial tumors. Due to its rarity, there are no guidelines regarding the systemic treatment of this disease. This report describes a case of a 76-year-old woman with colorectal carcinosarcoma with extensive metastatic burden treated with carboplatin and paclitaxel. After four cycles of chemotherapy, the patient had an excellent clinical and radiographical response to treatment. To the best of our knowledge, this is the first report addressing the use of carboplatin and paclitaxel in this disease. We reviewed seven published case reports of metastatic colorectal carcinosarcoma where various systemic treatments were offered. Remarkably, there are no previously published reports where even a partial response was noted, which underscores the aggressiveness of this disease. While further studies are required to validate our experience and assess long-term outcomes, this case suggests an alternative treatment regimen for metastatic colorectal carcinosarcoma.
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Affiliation(s)
- Changsu Lawrence Park
- Department of Medical Oncology, McGill University Health Center, McGill University, Montreal, QC H4A 3J1, Canada
| | - Charles Vincent Rajadurai
- Department of Medical Oncology, McGill University Health Center, McGill University, Montreal, QC H4A 3J1, Canada
| | - Tuyet Nhung Ton Nu
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC H4A 3J1, Canada
| | - Victoria Mandilaras
- Department of Medical Oncology, McGill University Health Center, McGill University, Montreal, QC H4A 3J1, Canada
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Maskrout M, Boutaggount F, Mokfi R, Ennibi G, Hnach Y, Tarchouli M, Rais G. Carcinosarcoma of the colon with extensive and extraordinary metastases detected on F-FDG18PET/CT: A case report. Ann Med Surg (Lond) 2022; 81:104450. [PMID: 36147121 PMCID: PMC9486715 DOI: 10.1016/j.amsu.2022.104450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Sarcomatoid carcinomas or carcinosarcomas are rare tumors with a double component, carcinomatous and sarcomatous. They most commonly arise from the head, neck, respiratory system and female genital tract. To the best of our knowledge, only thirty two cases of colorectal involvement have been reported in the medical litterature. Case report We report a case of sarcomatoid carcinoma of the colon in a 58 year old woman with unusual sites of metastasis revealed by a whole body 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), who presented with right iliac fossa pain. Physical examination revealed only tenderness of the right iliac fossa. A right hemi-colectomy was performed. The immunohistochemical study of the surgical specimen revealed 2 cellular contingents, one carcinomatous and the other sarcomatous, leading to the diagnosis of carcinosarcoma. The evolution was rapidly unfavourable, with death occurring 4 months after the initial surgery. Discussion Colorectal carcinosarcomas are very rare and aggressive tumors with high metastatic potential commonly in the liver, lymph nodes, and peritoneum. In our case, we order a FDG-PET/CT that revealed intriguing pattern of metastasis. Conclusion The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis of colorectal tumors and order more often FDG-PET/CT for a good clinical staging. Colorectal carcinosarcoma is rare and aggressive neoplasm. It is a biphasic tumor, exhibiting epithelial and stromal malignant differentiation. Whole body 18FDG-PET/CT is a potential modality for diagnosing advanced disease that might not be clinically apparent. Due to its rarity, the therapeutic management remains a challenge.
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