A case of 18 years disease-free survival after combined pancreatoduodenectomy and hemicolectomy for carcinosarcoma of the transverse colon

Abstract

Background: Ascertaining the origin of large tumors located in the region of the pancreas head and adjacent mesocolon can pose a challenge preoperatively. En bloc pancreatoduodenectomy with hemicolectomy is often required towards curative tumor resection (R0) of malignant tumors in this region.

Case presentation: Herein we report a case of a 48-year-old man with two contiguous masses each 5 cm in size, located in the pancreatic head. The masses were detected incidentally by abdominal ultrasonography at an annual health check. Endoscopic biopsies revealed inflammation with no malignancy. Cross-sectional imaging showed the tumor direct invasion of the uncinate process of the pancreas, and the third portion of the duodenum. Based on imaging, a malignant submucosal tumor originating from mesenchymal cells in the mesentery of the transverse colon was made preoperatively. The mass required en bloc pancreatoduodenectomy, right hemicolectomy, and resection of the superior mesenteric vein. The final pathology was carcinosarcoma of the transverse colon. The patient survived 18 years after surgery without recurrence.

Conclusions: Malignant tumors located in the region of the pancreas head should be considered for an en bloc curative tumor resection and adjuvant chemotherapy treatments offered that might be beneficial for carcinosarcoma.

Keywords: Carcinosarcoma; Pancreatoduodenectomy with hemicolectomy; Region of pancreas head.

Fig. 1

Ultrasonography showing two heterogeneous echogenic round contiguous masses, 5 cm in size each, at the region of the pancreatic head

Fig. 2

Abdominal computerized tomography (CT) showing two in-homogeneously enhanced round contiguous masses, 5 cm in size each, at the region of the pancreatic head (a), and the masses invading into the superior mesenteric vein (arrow) (b)

Fig. 3

Colonoscopy demonstrating a red, raised wheal with a minute ulcer in the transverse colon, indicating submucosal invasion of an extramural tumor. Endoscopic biopsies revealed inflammation with no malignancy

Fig. 4

Angiograms showing a hyper-vascular tumor fed by the right branch of the middle colic artery

Fig. 5

Histological examination revealing that a large part of the tumor was poorly differentiated adenocarcinoma, and pleomorphic sarcomatous tumor cells were seen in the part of hemorrhagic necrosis, where the transition of carcinomatous to sarcomatous tumor cells was observed (a). The carcinoma component was exposed in the ulcer base of the colon (b)

Fig. 6

Immunohistochemically, the carcinomatous component was positive for CK7 (a), CK20, EMA, CDX2, AFP, and partly positive for vimentin. On the other hand, the spindle-shaped pleomorphic sarcomatous component was strongly positive for vimentin (b)