Objective:The aim of this study was to investigate the CT and clinicopathologic fea-tures of sarcomatoid carcinoma(SC)of the upper gastrointestinal tract,and improve the understan-ding of this disease.Methods:CT images(including plain,arterial phase and portal venous phase ima-ges)and clinicopathologic information of 19 patients with pathologically confirmed upper gastrointes-tinal tract sarcomatoid carcinoma(SC)from August 2010 to April 2023 in our hospital were retro-spectively analyzed.The imaging data was observed and analyzed by two radiologists specialized in ab-dominal imaging,assessing the location,morphology,ratio of thick to long diameter,density,presence of ulcers on the mucosal surface,and the enhancement mode and degree of the lesions.Results:Of the 19 patients,13 were male and 6 were female.The median age was 66 years.These 19 cases included 11 cases of esophageal sarcomatoid carcinoma,7 cases of gastric sarcomatoid carcinoma and one case of duodenal sarcomatoid carcinoma.The lesions were mostly located in the mid esophagus and proximal stomach in 6(6/11)and 5(5/7)cases,respectively,with lesion length ranging from 7.26 to 72.07mm with mean value of(29.03±16.47)mm,the thickness ranging from 3.04 to 50.51mm with mean value of(18.41±10.95)mm,and the ratio of the thickness to the length ranged from 0.38 to 1.00 with mean value of 0.65±0.19.The tumor was mainly heterogeneous in density,CT values were about 13.83 to 60.83HU with mean values of(35.42±12.57)HU in the plain phases,34.63 to 102.88HU with mean value of(64.60±21.17)HU in the arterial phase,and 40.78 to 120.00HU with mean value of(74.17±19.63)HU in the portal venous phases.Calcification was seen in one case,interruption of adjacent mu-cosa was seen in 13 cases,and ulcer formation on the tumor surface was seen in 14 cases.Enhancement scan:the tumor showed inhomogeneous enhancement in 16 cases;the peak of tumor enhancement was in the portal vein stage in 16 cases;the tumor on the portal venous phases images showed mild en-hancement in 3 cases,moderate enhancement in 8 cases,and obvious enhancement in 8 cases.Conclu-sion:Upper gastrointestinal sarcomatoid carcinoma has the relative characteristics of large thickness-length ratio,uneven plain density,common necrotic capsule,and more common in the middle esopha-gus and proximal stomach.However,the imaging features under CT scan are mostly non-specific,and clear diagnosis depends on histopathology and immunohistochemistry.
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