Primary splenic carcinosarcoma with local invasion of chest wall: a rare case

Abstract

We herein present a case of carcinosarcoma arising as a primary lesion in the spleen with the presence of local invasion of chest wall prior to widespread metastasis all over the body of a female aged 64 years. The detailed information of therapy and imaging evidences of morphology, histology, and immunohistochemistry are fully provided. To the best of our knowledge, this is the fifth reported case of a primary splenic carcinosarcoma and even the first case to be described with local invasion in the mongoloid. Carcinosarcoma that develops in the spleen with local invasion is extremely rare.

Keywords: Spleen; Carcinosarcoma; Chest wall invasion.

Fig. 1

Imaging diagnosis (a) Chest radiograph showed a moderate amount of effusion of the left pleural cavity. (b, c) Computed tomography (CT) showed a high-density mass in the lower pole of the spleen (b), accompanied by multiple cystic solid mass in the spleen and a 6.1 cm×3.6 cm mass shadow with the bone destruction of the left anterior fifth rib (blue arrow) (c). (d, e) The positron emission tomography/computed tomography (PET/CT) scan confirmed multiple low-density mass and one high-density mass distributed in the spleen, and a soft tissue mass shadow with local rib destruction. There were no other abnormalities found on the PET/CT

Fig. 2

Pathological diagnosis (a) Gross section of spleen showing tumor nodule located in the lower pole. (b–e) Histological appearance of splenic carcinosarcoma: (b) shows the coexistence of tumor tissue and normal splenic tissue; (c) shows lots of necrotic tissues in the central region of the tumor; (d) shows the sarcomatous component composed of uniform spindle cells arranged in a fascicular pattern; (e) shows the carcinomatous component composed of irregular granular cells, showing frequent megakaryocytes. (f–g) Histological appearance of the metastatic tumor of the chest wall: (f) shows the tumor tissue invading the striated muscle; (g) shows the tumor tissue encompassing the nerve fiber. (h–j) Splenic carcinosarcoma immunohistochemistry: (h) indicates that sarcomatous areas show strong immunostaining for vimentin; (i) indicates that carcinomatous areas reveal strong positive staining for cytokeratin (CK; pan); (j) shows positive epithelial membrane antigen (EMA) immumohistochemistry