Sarcomatoid Carcinoma of the Stomach with Heterologous Elements

Abstract

We report a unique sarcomatoid carcinoma of the stomach that, in addition to having carcinomatous and sarcomatous components, also contained foci of heterologous cartilaginous differentiation. Gastric sarcomatoid carcinomas were reviewed by Iezzoni and Mills, but cartilaginous differentiation was not seen in any of their 30 cases.1 Robey-Cafferty and associates have also reported three cases, but none of them contained heterologous cartilaginous elements.2 One case report from Korea, however, mentions the presence of cartilage in a carcinosarcoma of the stomach. Case ReportA 46-year-old Saudi man was admitted to Asir Central Hospital with recent onset of dyspepsia, anorexia and weight loss. An endoscopic examination of the stomach was performed and a biopsy was taken. This initial biopsy was unsuccessful in demonstrating the tumor. On explorative laparotomy, however, a large tumor was found, necessitating total gastrectomy and splenectomy.The gastrectomy specimen measured 22 cm in length and 9 cm in diameter across the body of the stomach. When the stomach was opened along the greater curvature, a large ulcer was noted in the antral region, measuring 4x3 cm. The margins of the ulcer were edematous and elevated, with loss of mucosal rugosities around its circumference. The wall of the stomach beneath the ulcerated lesion was thickened (2.5 cm), with grayish-white homogeneous cut surfaces. Six lymph nodes were found along the greater curvature of the stomach, ranging in size from 0.4 to 0.9 cm in maximal dimension. The spleen measured 10x5.5x4 cm, and was grossly unremarkable. Microscopically, the ulcerated lesion of the stomach showed a biphasic tumor invading the full thickness of its wall. The tumor was composed of two distinct components, one being a moderately differentiated adenocarcinoma and the other being a sarcoma (Figure 1).The carcinomatous component consisted of irregular glands that were lined by stratified columnar cells containing hyperchromatic nuclei. These neoplastic glands were separated from each other by a sarcomatous stroma of pleomorphic spindle-shaped cells exhibiting frequent mitotic figures. There were clear-cut foci of chondroid differentiation among the sarcomatous elements, exhibiting significant nuclear atypia. Transition between carcinomatous and sarcomatous components was not seen, but the sarcomatous foci merged imperceptibly with cartilaginous foci. The tumor invaded deeply in the muscularis propria. A random section taken at a distance from the main tumor displayed foci of intestinal metaplasia and dysplasia. Gastric margins of resection, the lymph nodes and spleen were not involved by the tumor. DiscussionChondroid differentiation is rare in sarcomatoid carcinomas of the stomach, but it is not uncommon in those tumors that arise from the esophagus, small intestine 1 and colon. 5 In the 30 cases reviewed by Iezzoni and Mills, 1 the average age of the patients with gastric sarcomatoid carcinoma was 52 years, and 64% were males. These tumors arose from all portions of the stomach...

Gastric carcinosarcoma: A case report and review of the literature

“…The most common carcinoma component is tubular or papillary adenocarcinoma, while neuroendocrine carcinomatous differentiation is less common. The mesenchymal sarcomatous component is variable and may include leiomyosarcoma, rhabdomyosarcoma, osteosarcoma or chondrosarcoma (2).…”

Carcinosarcoma gástrico

“…El cuadro clínico de presentación suele ser el compuesto por dolor abdominal, dispepsia, astenia, pérdida de peso, hemorragia gástrica manifiesta o anemizante, y a veces como masa abdominal palpable (1,2,4). Macroscópicamente suele presentarse como un tumor endofítico (a veces exofítico) desde cuatro a más de veinte centímetros de diámetro, de aspecto polipoideo y a veces ulcerado, que infiltra profundamente la pared gástrica (1)(2)(3)(4).…”

“…Macroscópicamente suele presentarse como un tumor endofítico (a veces exofítico) desde cuatro a más de veinte centímetros de diámetro, de aspecto polipoideo y a veces ulcerado, que infiltra profundamente la pared gástrica (1)(2)(3)(4). En ocasiones se identifican adenopatías regionales durante la laparotomía (4).…”

“…Macroscópicamente suele presentarse como un tumor endofítico (a veces exofítico) desde cuatro a más de veinte centímetros de diámetro, de aspecto polipoideo y a veces ulcerado, que infiltra profundamente la pared gástrica (1)(2)(3)(4). En ocasiones se identifican adenopatías regionales durante la laparotomía (4). El diagnóstico suele ser difícil y tardío, ya que apenas se diferencia clínica, endoscópica o radiológica-mente del adenocarcinoma gástrico, precisando de estudios ultraestructural e inmunohistoquímico para diferenciarlo además de otros tumores escamosos, sarcomatosos o mesenquimales, sobre todo de los GIST y de los pólipos fibroides inflamatorios (2,4).…”

“…En ocasiones se identifican adenopatías regionales durante la laparotomía (4). El diagnóstico suele ser difícil y tardío, ya que apenas se diferencia clínica, endoscópica o radiológica-mente del adenocarcinoma gástrico, precisando de estudios ultraestructural e inmunohistoquímico para diferenciarlo además de otros tumores escamosos, sarcomatosos o mesenquimales, sobre todo de los GIST y de los pólipos fibroides inflamatorios (2,4).…”