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Ma Y, Yang Y, Zhang H, Mugaanyi J, Hu Y, Wu S, Lu C, Mao S, Wang K. Sarcomatoid carcinoma of the pancreas (Review). Oncol Lett 2024; 28:477. [PMID: 39161336 PMCID: PMC11332573 DOI: 10.3892/ol.2024.14610] [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: 10/31/2023] [Accepted: 06/20/2024] [Indexed: 08/21/2024] Open
Abstract
Sarcomatoid carcinoma of the pancreas (SCP) is a rare and aggressive subtype of undifferentiated pancreatic ductal adenocarcinoma, with a generally poor prognosis and only sporadic cases reported worldwide. Histologically, the most notable feature of SCP is the presence of abundant of mesenchymatoid spindle tumor cells in the tumor, which lack glandular differentiation. Immunohistochemically, SCP is characterized by the expression of both mesenchymal and epithelial markers. With only a few reported cases, there is limited knowledge about its molecular and clinicopathological characteristics. Therefore, the present study performed a literature search to identify all relevant published studies. The present review provides an overview of the histogenesis, diagnosis, genetic features, prognosis and treatment of SCP, specifically focusing on the molecular alterations. Furthermore, a single-center experience is reported, which adds to the limited evidence available in the literature.
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Affiliation(s)
- Yijie Ma
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Yiwen Yang
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Huizhi Zhang
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Joseph Mugaanyi
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Yangke Hu
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Shengdong Wu
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Caide Lu
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Shuqi Mao
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
| | - Ke Wang
- Department of Hepatobiliary Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang 315048, P.R. China
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Feng L, Tang X, You Z. Undifferentiated sarcomatoid carcinoma of the pancreas-a single-institution experience with 23 cases. BMC Cancer 2024; 24:250. [PMID: 38389041 PMCID: PMC10885366 DOI: 10.1186/s12885-024-11988-2] [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] [Received: 10/18/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The clinical course and surgical outcomes of undifferentiated sarcomatoid carcinoma of the pancreas (USCP) remain poorly characterized owing to its rarity. This study aimed to describe the histology, clinicopathologic features, perioperative outcomes, and overall survival (OS) of 23 resected USCP patients. METHODS We retrospectively described the histology, clinicopathologic features, perioperative outcomes and OS of patients who underwent pancreatectomy with a final diagnosis of USCP in a single institution. RESULTS A total of 23 patients were included in this study. Twelve patients were male, the median age at diagnosis was 61.5 ± 13.0 years (range: 35-89). Patients with USCP had no specific symptoms and characteristic imaging findings. The R0 resection was achieved in 21 cases. The En bloc resection and reconstruction of mesenteric-portal axis was undertaken in 9 patients. There were no deaths attributed to perioperative complications in this study. The intraoperative tumor-draining lymph nodes (TDLNs) dissection was undergone in 14 patients. The 1-, 3- and 5-year survival rates were 43.5%, 4.8% and 4.8% in the whole study, the median survival was 9.0 months. Only 1 patient had survived more than 5 years and was still alive at last follow-up. The presence of distant metastasis (p = 0.004) and the presence of pathologically confirmed mesenteric-portal axis invasion (p = 0.007) was independently associated with poor OS. CONCLUSIONS USCP was a rare subgroup of pancreatic malignancies with a bleak prognosis. To make a diagnose of USCP by imaging was quite difficult because of the absence of specific manifestations. Accurate diagnosis depended on pathological biopsy, and the IHC profile of USCP was mainly characterized by co-expression of epithelial and mesenchymal markers. A large proportion of patients have an early demise, especially for patients with distant metastasis and pathologically confirmed mesenteric-portal axis invasion. Long-term survival after radical resection of USCPs remains rare.
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Affiliation(s)
- Lei Feng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, No.37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Xiaojuan Tang
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, No.37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, China
| | - Zhen You
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, No.37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, China.
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Ford JA, Bhatt A, Kim RC, Larkins M, Burke AM. Primary squamous cell carcinoma of the pancreas: an update on a rare neoplasm from the SEER database. Front Oncol 2023; 13:1272740. [PMID: 38130988 PMCID: PMC10733453 DOI: 10.3389/fonc.2023.1272740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/05/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Pancreatic squamous cell carcinoma is a rare type of pancreatic cancer of ductal origin, composing an estimated 0.5 - 5% of pancreatic ductal malignancies. As a result, epidemiology, treatment options, and associated outcomes are poorly understood and understudied. Our aim was two-fold: to evaluate demographic trends and analyze overall survival (OS) associated with different treatment modalities for this rare malignancy. Methods Patients with pancreatic squamous cell carcinoma diagnosed between 1992 and 2019 were eligible and reviewed utilizing the Surveillance, Epidemiology, and End Results Registry (SEER) database. Data was analyzed using SPSS and python packages lifelines and pandas. Variables of interest included stage at diagnosis as well as the receipt of surgery, radiotherapy, and/or chemotherapy. Five-year OS curves were analyzed using Kaplan-Meier probability stratified by treatment modality. Results Of 342 cases of pancreatic squamous cell carcinoma, 170 (49.7%) were females and 172 (50.3%) were males. 72 (21.1%) of patients received radiotherapy, 123 (35.9%) patients received chemotherapy, and 47 (13.7%) received surgery. Patients who were diagnosed under the age of 50 had prolonged survival time compared to those diagnosed over the age of 50 (12 vs 8 months, respectively, p < 0.001). This trend was evident despite the lack of a significant association between age at diagnosis and presence of metastases (p = 0.524). The median OS was 3 months for the entire cohort and there was a significant difference in median survival time noted across treatment modalities: OS was prolonged in those receiving surgery compared to those receiving chemotherapy or radiotherapy alone (30 vs 2 months, respectively, (p<0.001)). Receipt of radiotherapy was not associated with a significant difference in OS compared to those who did not receive radiotherapy. Conclusion Pancreatic squamous cell carcinoma is a rare subtype of pancreatic cancer and typically portends a poor prognosis. As demonstrated by our study, surgery offers prolonged overall survival compared to other treatment modalities. Age at diagnosis and presence of metastatic disease are also important prognostic factors likely related to patients' ability to tolerate surgery or physician willingness to offer surgery. Given the importance of surgery on outcomes, it may be reasonable to offer it in the oligometastatic setting in patients who are otherwise a good candidate. Future research on larger cohorts is warranted to investigate the role that modality selection plays in overall survival rates in this understudied malignancy.
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Affiliation(s)
- Jacob A. Ford
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Arjun Bhatt
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Rachel C. Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael Larkins
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Aidan M. Burke
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
- Department of Radiation Oncology, East Carolina University (ECU) Health, Greenville, NC, United States
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Gkountakos A, Simbolo M, Bariani E, Scarpa A, Luchini C. Undifferentiated Sarcomatoid Carcinoma of the Pancreas: From Histology and Molecular Pathology to Precision Oncology. Int J Mol Sci 2022; 23:1283. [PMID: 35163206 PMCID: PMC8835772 DOI: 10.3390/ijms23031283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 12/12/2022] Open
Abstract
Undifferentiated sarcomatoid carcinoma of the pancreas (SCP) is a rare and aggressive subtype of pancreatic cancer. Histologically, SCP is a poorly differentiated tumor characterized by the lack of glandular differentiation and the presence of mesenchymal-like, spindle-shaped tumor cells. Due to its rarity, only sporadic cases have been reported, while its molecular characterization has not been sufficiently described. Surgical resection with curative intent is the gold-standard of SCP management, but this strategy is possible only in a small proportion of cases due to SCP early metastasization. Although SCP is generally associated with a poor prognosis, some clinical cases amenable to surgical resection and followed by adjuvant chemotherapy have demonstrated a remarkably long survival. Preliminary molecular insights on the SCP molecular landscape have demonstrated the recurrent presence of KRAS and TP53 mutations, highlighting genetic similarities with conventional pancreatic ductal adenocarcinoma (PDAC). Although the use of immunotherapy in PDAC remains an unmet challenge, recent insights indicated a potentially significant role of the PD-L1/Notch3 axis in SCP, opening new horizons for immunotherapy in this cancer subtype. In this review, we described the most important clinic-pathologic features of SCP, with a specific focus on their molecular landscape and the potential targets for precision oncology.
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Affiliation(s)
- Anastasios Gkountakos
- ARC-NET Applied Research on Cancer Center, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.)
| | - Michele Simbolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
| | - Elena Bariani
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
| | - Aldo Scarpa
- ARC-NET Applied Research on Cancer Center, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
| | - Claudio Luchini
- ARC-NET Applied Research on Cancer Center, University of Verona, 37134 Verona, Italy; (A.G.); (A.S.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy; (M.S.); (E.B.)
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Toledo PF, Berger Z, Carreño L, Cardenas G, Castillo J, Orellana O. Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature. World J Clin Cases 2021; 9:3716-3725. [PMID: 34046475 PMCID: PMC8130075 DOI: 10.12998/wjcc.v9.i15.3716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/17/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma of the pancreas (SCP) is a rare type of pancreatic neoplasm, and only a few cases have been described in the literature. Histologically, it is composed mostly of atypical spindle cells with apparent sarcomatous features.
CASE SUMMARY This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain. Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy. En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor. Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion. After surgery, the patient did not receive chemotherapy. Previous studies indicate a poor prognosis for this type of malignancy. However, our patient has survived for 35 mo with no recurrence to date.
CONCLUSION The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.
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Affiliation(s)
- Paulina F Toledo
- Department of Gastroenterology, Hospital Clinico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Zoltan Berger
- Department of Internal Medicine, Section Gastroenterology, Hospital Clinico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Laura Carreño
- Department of Pathology, Hospital Clínico de la Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Gonzalo Cardenas
- Department of Radiology, Hospital Clínico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Jaime Castillo
- Department of Surgery, Hospital Clínico Universidad de Chile, Santiago 834456, Independencia, Chile
| | - Omar Orellana
- Department of Surgery, Hospital Clínico Universidad de Chile, Santiago 834456, Independencia, Chile
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Zhao S, Su W, Deng L, Chen Y, Zuo C, Shao C, Ren F. Pancreatic sarcomatoid carcinoma: CT, MRI, and 18F-FDG PET/CT features. Clin Radiol 2020; 75:397.e7-397.e14. [PMID: 32044096 DOI: 10.1016/j.crad.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
AIM To investigate computed tomography (CT), magnetic resonance imaging (MRI), and combined 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/CT features of pancreatic sarcomatoid carcinoma (PSC). MATERIALS AND METHODS The hospital database was searched retrospectively for the patients with PSC confirmed at histopathology after surgery. Ten patients who underwent unenhanced and enhanced CT (n=4), unenhanced and enhanced MRI (n=2), 18F-FDG PET/CT (n=2), and both enhanced CT and 18F-FDG PET/CT (n=2) were enrolled. Two patients underwent additional delayed PET/CT. The maximum standardised uptake value (SUVmax) was measured on PET/CT images. RESULTS Eleven lesions were detected in 10 patients. Solid and cystic components (n=6), intratumoural haemorrhage (n=1), nodular calcification (n=2), main pancreatic duct dilatation resulted from lesion obstruction (n=5) or compression (n=3), cholangiectasis (n=5), vascular and peripheral organ invasion (n=5 and 6, respectively), hepatic and lymphatic metastases (n=4 and 2, respectively) were detected. All five lesions in four patients who underwent PET/CT showed intense FDG uptake on PET/CT with SUVmax (16, range 10.9-21.1). Increase of FDG uptake (SUVmax = 18.9, 20.1, and 27.3, respectively) was revealed on the delayed scan of three lesions in two patients. CONCLUSIONS PSCs were more commonly ill-defined solid cystic masses, which caused pancreatic duct obstruction/compression without pancreatic parenchymal atrophy, and these masses on PET/CT showed high FDG uptake on both initial and delayed PET/CT.
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Affiliation(s)
- S Zhao
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - W Su
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - L Deng
- Department of Pathology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Y Chen
- Department of Pathology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - C Zuo
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China
| | - C Shao
- Department of Radiology, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
| | - F Ren
- Department of Nuclear Medicine, Changhai Hospital, No. 168, Changhai Road, Yangpu District, Shanghai, 200433, China.
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