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Nagose VB, Ingle SS, Chandak NO, Gondane SR. A Rare Cutaneous Malignancy: A Primary Cutaneous Carcinosarcoma with Adnexal Epithelial Component (Trichoblastic Carcinosarcoma) of Left Temporal Region. Indian J Dermatol 2024; 69:77-80. [PMID: 38572039 PMCID: PMC10986867 DOI: 10.4103/ijd.ijd_243_23] [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] [Indexed: 04/05/2024] Open
Abstract
Primary cutaneous carcinosarcoma (PCCS) is a rare cutaneous biphasic tumour with just 120 cases being reported till date. The epithelial component trichoblastic carcinoma/ malignant trichoblastoma (trichoblastic carcinosarcoma) is even rarer, so is the present case. An eighty years old male patient presented with a rapidly progressing ulceroproliferative nodular growth on the left temporal region. The incisional biopsy showed primary cutaneous carcinomasarcoma (PCCS). IHC showed epithelial and stromal component marked exclusively for pancytokeratin (AE1/AE3) CK5&6/ p40 and vimentin respectively. Both components were immunopositive for D2-40 and immunonegative for BerEP4/ S100/ Melan A/ MITF, thus final diagnosis given was Trichoblastic carcinosarcoma. Wide excision of the lesion with local rotation flap and skin grafting (thigh skin) was done. Patient remains disease free after four years also. Present case thus highlights the importance of HPE, IHC and early surgery for excellent prognosis of PCCS.
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Affiliation(s)
- Vaishali B. Nagose
- From the Department of Pathology, GMC, Sindhudurg, Maharashtra, India
- Department of Pathology, DUPMC, Jalgaon, Maharashtra, India
| | | | - Nilesh O. Chandak
- Department of Surgical Oncology, Consultant Surgical Oncologist, Chandak Cancer Hospital, Jalgaon, Maharashtra, India
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2
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Born LJ, Khachemoune A. Basal cell carcinosarcoma: a systematic review and reappraisal of its challenges and the role of Mohs surgery. Arch Dermatol Res 2023; 315:2195-2205. [PMID: 36790451 DOI: 10.1007/s00403-023-02551-3] [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: 12/23/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 02/16/2023]
Abstract
Basal cell carcinosarcoma (BCCS) is a rare malignant biphasic tumor of the skin, composed of epithelial and mesenchymal components, and may be underdiagnosed. We sought to summarize the current understanding of BCCS including its reported history, clinical presentation, diagnosis, and treatment. We also reappraise and present our recommendations of histological interpretation for its diagnosis and treatment. A systematic review of PubMed and EMBASE, from inception of databases to December 1, 2022, identified all reported cases of basal cell carcinosarcoma. A total of 34 reports containing 54 patients with basal cell carcinosarcoma were included. The neoplasm was most commonly associated in areas of sun-exposed skin and primarily affected the elderly. Diagnosis was made on histology specimens using H&E. To address underdiagnosis, additional immunohistochemical markers have been proposed due to unreliable phenotypic appearance in this poorly differentiated neoplasm. Treatment consists of excision of the tumor, typically with Mohs surgery, and is curative in most cases. There are limited treatment options for metastatic disease. There were limitations to this study as various immunohistochemical stains used on suspected BCCS without providing an explanation as to why certain markers were included and others were excluded. Continued efforts in characterizing this complex neoplasm are critical in establishing reliable and accurate diagnostic tests and accompanying treatment options, especially in cases of metastatic disease.
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Affiliation(s)
- Louis J Born
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, and State University of New York, New York, NY, USA.
- Veterans Affairs Hospital and SUNY Downstate Dermatology Service, 800 Poly Place, Brooklyn, NY, 11209, USA.
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Ndukwe CO, Chiemeka ME, Menkiti FE, Ezejiofor FI, Ike GK, Chukwuanukwu TO. Primary Carcinosarcoma of the Skin in an African Albino: Case Report and Review of Literature. Oman Med J 2022; 37:e417. [PMID: 36299803 PMCID: PMC9579781 DOI: 10.5001/omj.2022.07] [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: 05/07/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
Albinism results from a deficiency of the protein responsible for melanin production in melanocytes. Albinos are at an increased risk of dermatoses and malignancies. Primary carcinosarcoma of the skin is an exceedingly rare biphasic tumor composed of malignant epithelial and mesenchymal elements with an unclear histogenesis. To our knowledge, this has not been reported in an African albino. Here, we report the index case of this rare tumor in an albino of African descent.
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Affiliation(s)
- Chinedu Onwuka Ndukwe
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Medicine, College of Health Sciences and Technology, Nnamdi Azikiwe University, Anambra State, Nigeria
| | - Michael Emeka Chiemeka
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Medicine, College of Health Sciences and Technology, Nnamdi Azikiwe University, Anambra State, Nigeria
| | - Felix Emeka Menkiti
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Medicine, College of Health Sciences and Technology, Nnamdi Azikiwe University, Anambra State, Nigeria,Corresponding author: *
| | - Florence Ifeoma Ezejiofor
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Medicine, College of Health Sciences and Technology, Nnamdi Azikiwe University, Anambra State, Nigeria
| | - Gerald Kenechi Ike
- Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Anambra State, Nigeria
| | - Titus O. Chukwuanukwu
- Department of Surgery, Faculty of Medicine, College of Health Sciences and Technology, Nnamdi Azikiwe University, Anambra State, Nigeria
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Genenger B, Perry JR, Ashford B, Ranson M. A tEMTing target? Clinical and experimental evidence for epithelial-mesenchymal transition in the progression of cutaneous squamous cell carcinoma (a scoping systematic review). Discov Oncol 2022; 13:42. [PMID: 35666359 PMCID: PMC9170863 DOI: 10.1007/s12672-022-00510-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a disease with globally rising incidence and poor prognosis for patients with advanced or metastatic disease. Epithelial-mesenchymal transition (EMT) is a driver of metastasis in many carcinomas, and cSCC is no exception. We aimed to provide a systematic overview of the clinical and experimental evidence for EMT in cSCC, with critical appraisal of type and quality of the methodology used. We then used this information as rationale for potential drug targets against advanced and metastatic cSCC. All primary literature encompassing clinical and cell-based or xenograft experimental studies reporting on the role of EMT markers or related signalling pathways in the progression of cSCC were considered. A screen of 3443 search results yielded 86 eligible studies comprising 44 experimental studies, 22 clinical studies, and 20 studies integrating both. From the clinical studies a timeline illustrating the alteration of EMT markers and related signalling was evident based on clinical progression of the disease. The experimental studies reveal connections of EMT with a multitude of factors such as genetic disorders, cancer-associated fibroblasts, and matrix remodelling via matrix metalloproteinases and urokinase plasminogen activator. Additionally, EMT was found to be closely tied to environmental factors as well as to stemness in cSCC via NFκB and β-catenin. We conclude that the canonical EGFR, canonical TGF-βR, PI3K/AKT and NFκB signalling are the four signalling pillars that induce EMT in cSCC and could be valuable therapeutic targets. Despite the complexity, EMT markers and pathways are desirable biomarkers and drug targets for the treatment of advanced or metastatic cSCC.
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Affiliation(s)
- Benjamin Genenger
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
| | - Jay R Perry
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Bruce Ashford
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Marie Ranson
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
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5
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Seine AJ, Aronson A, Tallon B, Mortimer NJ. A rare cutaneous tumour. Clin Exp Dermatol 2022; 47:791-794. [PMID: 34984725 DOI: 10.1111/ced.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
A clinicopathological correlation case of a rare cutaneous tumour, which demonstrated a very rare recurrence with uncertainty remaining over the long-term prognosis for the patient.
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Affiliation(s)
| | | | - B Tallon
- Skin Dermatology Institute, Tauranga Specialist Centre, Tauranga, New Zealand
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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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Hamie L, Abbas O, Kurban M, Bhawan J. Osteoclast-Like Giant Cells: Focus on Entities Relevant to Dermatopathology and Underlying Pathogenesis. Am J Dermatopathol 2021; 43:163-173. [PMID: 33595228 DOI: 10.1097/dad.0000000000001769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Osteoclast-like giant cells (OLGCs) resemble osteoclasts with their abundant cytoplasm and well-developed organelles. OLGCs are characteristic features of giant cell tumor of the tendon sheath and giant cell tumor of soft tissue but they have also been described in numerous other cutaneous conditions. The diagnostic and prognostic significance of the presence of OLGCs is unknown. Here, we summarize the clinical entities that can exhibit these cells to avoid a histological overlap, affecting diagnosis and management.
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Affiliation(s)
- Lamiaa Hamie
- Dermatology Resident, Dermatology Department, American University of Beirut, Beirut, Lebanon
| | - Ossama Abbas
- Professor, Dermatology Department, American University of Beirut, Beirut, Lebanon
| | - Mazen Kurban
- Associate Professor, Dermatology Department, American University of Beirut, Beirut, Lebanon ; and
| | - Jag Bhawan
- Professor, Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA
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Heathcote J, Moss P, Walsh N, Archibald C. Basal cell carcinosarcoma of the eyelid with osteosarcomatous transformation. Saudi J Ophthalmol 2021; 35:257-260. [PMID: 35601854 PMCID: PMC9116097 DOI: 10.4103/sjopt.sjopt_35_21] [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: 02/17/2021] [Revised: 03/03/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
A carcinosarcoma is a neoplasm with malignant epithelial and mesenchymal components. It is thought to arise by mesenchymal transformation of the epithelial elements. The cutaneous form of carcinosarcoma is rare and is associated with sun exposure; most cases arise in the head and neck. The epithelial component may be a basal cell carcinoma, a squamous cell carcinoma, or an adnexal carcinoma. The mesenchymal component may be an osteosarcoma, a pleomorphic undifferentiated sarcoma, or another type of sarcoma. Only a few cases of cutaneous carcinosarcoma have been described in the periocular skin. We present a case of basal cell carcinosarcoma with osteosarcoma and pleomorphic undifferentiated sarcoma arising in the lower eyelid of an elderly man.
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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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10
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García-Souto F, Pereyra-Rodriguez JJ, Cabrera-Perez R, Durán-Romero AJ, Escudero-Ordoñez J, Conejo-Mir J. Primary cutaneous carcinosarcoma: clinical, histological, and immunohistochemical analysis of eight cases. Int J Dermatol 2020; 60:93-98. [PMID: 32530054 DOI: 10.1111/ijd.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cutaneous carcinosarcoma is a rare biphasic tumor comprising malignant epithelial and heterologous mesenchymal elements. Data on the clinical and histopathologic characteristics of this tumor are scarce. The objective of this study was to describe the clinicopathologic and immunohistochemical features of cutaneous carcinosarcoma. METHODS A descriptive retrospective study was conducted in a tertiary care hospital from Spain. We reviewed the records of eight patients with cutaneous carcinosarcoma who were diagnosed from 2009 to 2019. RESULTS The mean patient age at diagnosis was 72.13 years (range 44-91 years), and there was a male predilection (6 cases). The most common site of cutaneous carcinosarcoma was the head and neck (5 cases). Carcinosarcomas demonstrated variable histopathological and immunohistochemical features. Follow-up was available for 7-8 patients. There were two cases of local recurrence and one case of metastasis. Two patients died from the tumor during the entire follow-up. CONCLUSIONS Although the number of cases in this study was limited, our results provide valuable insight into the clinical, histopathologic, and immunohistochemical characteristics of primary cutaneous carcinosarcoma.
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Affiliation(s)
| | | | - Rocío Cabrera-Perez
- Department of Pathology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Julián Conejo-Mir
- Department of Dermatology, Hospital Universitario Virgen del Rocío, Seville, Spain
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Immunohistochemical evaluation of mismatch repair proteins and p53 expression in extrauterine carcinosarcoma/sarcomatoid carcinoma. Contemp Oncol (Pozn) 2020; 24:1-4. [PMID: 32514231 PMCID: PMC7265955 DOI: 10.5114/wo.2020.94718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/14/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Carcinosarcoma (CS) is a tumor with components: epithelial (carcinomatous) and mesenchymal (sarcomatous), developing in the mechanism of epithelial-mesenchymal transition. It is known that the p53 defect is a frequent finding in a carcinosarcoma in different anatomical locations, additionally, in a subgroup of uterine CS MMR defect plays a role in the pathogenesis. The aim of this paper was to investigate the frequency of MMR and p53 aberrations in extrauterine CS. Material and methods Twenty eight extrauterine CS from the lung (n = 8), breast (n = 6), head and neck (n = 5), ovary (n = 3), urinary bladder (n = 3), adrenal gland (n = 1), skin (n = 1), and stomach (n = 1) were stained for hMLH1, PMS2, hMSH2, hMSH6 and p53. The pattern of expression was evaluated separately in carcinomatous and sarcomatous component. Results Immunostainings for hMLH1, PMS2, hMSH2 and hMSH6 were positive in all tumors. p53 defect was observed in 19 out of 28 samples (67.85%). In all cases except one (96.42%) there was a concordance between sarcomatoid and carcinomatous components. Conclusions MMR deficiency does not seem to play a role in the pathogenesis of extrauterine CS. p53 aberrant expression is frequent and almost always consistent in carcinomatous and sarcomatous component.
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Davis K, Whale K, Tran S, Hamilton S, Kandamany N. A rare case of cutaneous basal cell carcinosarcoma in an immunosuppressed patient. Pathology 2020; 52:267-268. [PMID: 31918851 DOI: 10.1016/j.pathol.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Katherine Davis
- Department of Plastic and Reconstructive Surgery, Royal Hobart Hospital, Hobart, Australia.
| | - Karen Whale
- Department of Anatomical Pathology, Royal Hobart Hospital, Hobart, Australia
| | - Sonia Tran
- Department of Plastic and Reconstructive Surgery, Royal Hobart Hospital, Hobart, Australia
| | - Sam Hamilton
- Department of Plastic and Reconstructive Surgery, Royal Hobart Hospital, Hobart, Australia
| | - Nanda Kandamany
- Department of Plastic and Reconstructive Surgery, Royal Hobart Hospital, Hobart, Australia
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Li JJX, Ng JKM, Choi PCL, Lee JHS, Yu MY. Trichoblastic Carcinosarcoma Arising From the Vagina: A Case Report With Comprehensive Immunophenotypic Analysis. Int J Surg Pathol 2019; 28:440-446. [PMID: 31747847 DOI: 10.1177/1066896919887803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 54-year-old woman presented with abdominal pain. Magnetic resonance imaging revealed an upper vaginal mass with no pelvic side wall involvement, nodal, or distant metastasis. Radical hysterectomy was performed. Histology showed trichoblastic carcinoma with hair follicle structures and malignant sarcomatous and carcinomatous components. Hair follicular differentiation was confirmed by positivity to hair follicle markers (Bcl-2, TLE1, CD56/NCAM, and TDAG51) and presence of CD10-positive trichogenic stroma. The tumor involved the vaginal muscularis only (FIGO [International Federation of Gynecology and Obstetrics] stage I) and was excised with clear margins. The patient remained disease free at 3-month follow-up. This is the first case of cutaneous-type carcinosarcoma reported in the vagina, highlighting the difference in histology, immunophenotype, and behavior compared with gynecologic carcinosarcomas.
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Affiliation(s)
- Joshua Jing Xi Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Joanna Ka Man Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Paul Cheung Lung Choi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jacqueline Ho Sze Lee
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Mei-Yung Yu
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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