Colorectal Sarcomatoid Carcinoma: a Rare Condition with Poor Outcomes

Welten, Vanessa M.; Lu, Pamela; Fields, Adam C.; Yoo, James J.; Melnitchouk, Nelya

doi:10.1007/s11605-020-04709-0

Cited by 6 publications

(2 citation statements)

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“…A recently published search of the National Cancer Database identified 75 patients with a reported CRC with sarcomatoid components 54 . Although individual case data, such as histopathologic findings and histochemical/immunohistochemical features, were not available in this aggregated review, the study found that the disease had a slight male predominance (61%), more than half of patients were over the age of 70 (52%), and 33% of patients had distant metastatic disease at presentation.…”

Section: Discussionmentioning

confidence: 97%

“…Carcinoma with sarcomatoid components is extremely rare, with ~50 reported cases 4–53 and one National Cancer Database search 54 previously published in the literature, the former exclusively as single-case reports. These publications usually employed the term “carcinosarcoma” or “sarcomatoid carcinoma,” with the specific term “carcinoma with sarcomatoid components” not used in the literature before the 2019 publication of the latest WHO classification.…”

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Colorectal Carcinoma With Sarcomatoid Components

Golconda,

McHugh,

Allende

et al. 2023

American Journal of Surgical Pathology

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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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Section: Discussionmentioning

confidence: 97%

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confidence: 99%