Sarcomatoid carcinoma of the stomach: A very rare and extremely aggressive tumor; a case report

Abstract

Introduction: Sarcomatoid carcinoma of the stomach is a very rare type of malignant gastric tumor characterized by distinct cell morphology.Only six cases have been reported in the literature. We report a case which illustrates the great rapidity of evolution and the aggressiveness of this histological type.

Case presentation: A 80-year-old patient was explored for loss of 20 kg and epigastralgia. The explorations showed a non-metastatic antral sarcomatoid carcinoma with celiac necrotic lymphe node. The oncologic comitee decision was surgery straight away without perioperative chemotherapy.4 weeks after his first CT scan the patient was admitted for preparation for surgery. Clinical and morphological examination showed a clear increase in tumor size with associated tumor infection.The patient had distal gastrectomy. The tumor was perforated and locally advanced.The final pathological exams confirmed the histological type. Surgery was R0, but 4 months after surgery, local recurrence compressing gastro intestinal anastomosis was occurred.

Clinical discussion: Operative difficulties and rapid recurrence after surgery would have been avoided by faster surgery after diagnosis. However, the surgery time was only 1 month, which illustrates the rapid evolution of sarcomatoid tumors.

Conclusion: Sarcomatoid carcinoma is a rare tumor. These tumors can be aggressive with a large tumoral voulume and high rate of locoregional lymph node involvement. Our case illustrate the aggressiveness of this tumor. The benefit of peri-operative treatment is unknown.

Keywords: Case report; Evolution; Gastric cancer; Sarcomatoid carcinoma.

Fig. 1

First CT scan. 1 a large necrotic adenopathy next to the celiac trunk (arrow). 1 b et 1 c: large antropyloric tumor.

Fig. 2

CT scan 1 months after diagnostic: Significant increase in tumor volume and infiltration of the peri-gastyric region.

Fig. 3

operative specimen 3a perforated antro-pyloric tumor(arrow) clogged by the gallbladder 3b: gastrectomy specimen: large tumor occupying the entire lumen.

Fig. 4

Pathological exam 4 a: HE*40: poorly differentiated neoplastic cells with deeply eosinophilic cytoplasm and pleomorphic nuclei(Arrow) 4b HE*40: focally some isolated tumour glands (Arrow) 4c: HE*200: sarcomatoid contingent with strongly atypical cells and multinucleated giant cells (Arrow) type “osteoclast-like”.

Fig. 5

Immunohistochemistry 5a: Cytokeratin AE1/AE3 * 100: strongly and diffuse stain in the undifferentiated contingent 5b: Vimentin *200: weak stain in the sarcomatoid area.