Carcinosarcoma of the stomach: a case report and review of the literature

Abstract

Carcinosarcomas are rare, malignant, biphasic tumors. We report the case of a 62-year-old man with gastric carcinosarcoma, along with its clinical, macroscopic and histopathological features. Macroscopically, a specimen of deformed stomach was obtained that measured 200 mm x 150 mm x 100 mm. A 150 mm x 100 mm x 50 mm exophytic tumoral mass (Borrmann type I) was found, which involved the posterior wall from the cardia to the antrum. Histopathologically, a mixed type of malignancy was revealed: an adenocarcinoma with intestinal metaplasia, with interposed fascicles of fusiform atypical cells and numerous large, rounded and oval cells. The tumor showed positive histochemistry for cytokeratin 18, epithelial membrane antigen, carcinoembryonic antigen, chromogranin A and vimentin. Liver metastases were diagnosed 8 mo postoperatively, and the patient died 4 mo later. A review of the available literature is also presented.

Figure 1

CT scan of the abdomen showing tumor (arrows). AB, CD: tumor diameters.

Figure 2

Macroscopic specimen obtained during surgery. Tumor underwent central necrosis, and a hemorrhagic zone is visible on the periphery.

Figure 3

Massive lymph node infiltration with tumor cells. Only a few tubules can be seen on the lymph-node periphery. In between and all around, large polygonal cells are haphazardly arranged (sarcomatous component). This appearance resembles that of the main tumor mass. A: hematoxylin-eosin (HE), × 50; B: HE, × 100.

Figure 4

Cytokeratin-18-positive epithelial cells arranged in tubules (× 400).

Figure 5

Vimentin-positive polygonal tumor cells (× 400).