Primary gastric carcinosarcoma:Clinicopathological analysis of 4 cases and literature review
Objective:Carcinosarcoma refers to malignant tumors containing both carcinoma and sarcoma components,with high malignancy.Primary gastric carcinosarcoma is rare.This study aims to investigate the clinicopathological features of primary gastric carcinosarcoma to improve the understanding of this tumor.Methods:Four cases of primary gastric carcinosarcoma admitted to the First Affiliated Hospital of Soochow University from January 2017 to January 2023 were retrospectively analyzed.Their clinicopathological features,immunohistochemical results,and prognosis in conjunction with literature were summarized and analyzed.Results:Among the four cases,there were three males and one female,with a mean age of 69.8 years.Three cases presented with abdominal pain,and one case presented with persistent black stool.The tumors were located in the cardia in one case,the fundus in one case,and the antrum in two cases.Macroscopically,the tumors were protruding masses,with two cases classified as Borrmann type I,and two cases showing necrosis,classified as Borrmann type Ⅱ,with an average maximum diameter of 7.1 cm.Microscopically,the tumors consisted of carcinoma and sarcoma components.The carcinoma components included tubular adenocarcinoma,papillary adenocarcinoma,hepatoid adenocarcinoma,and squamous cell carcinoma.The sarcomatous components included rhabdomyosarcoma,spindle cell undifferentiated sarcoma,and pleomorphic undifferentiated sarcoma.There was significant variability in the proportion of the two components,with sarcoma components ranging from 10%to 95%.Immunohistochemical results showed cytokeratin(CK)(AE1/AE3)expression in carcinoma components and vimentin expression in sarcoma components.Tubular and papillary adenocarcinomas expressed CK7 and CK18.Squamous cell carcinoma expressed CK5/6,protein(P)63,and P40.Hepatoid adenocarcinoma expressed alpha-fetoprotein and proteoglycan 3(glypican-3).During a follow-up period of 1 to 36 months,one case received adjuvant radiotherapy and chemotherapy after surgery,three cases did not receive radiotherapy and chemotherapy,two cases died at 2 and 36 months after surgery,respectively,and the remaining two cases survived.Conclusion:Primary gastric carcinosarcoma is rare and highly malignant.Combined HE morphology and immunohistochemistry can aid in the diagnosis and differential diagnosis of this tumor.
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