Scientific Letter
Carcinosarcoma of the Colon: Presentation of a Case
Carsinosarcoma de colon: a propósito de un caso
Núria Peris Tomas
, Arturo García Lozano, Rosario Martínez García, Gonzalo Garrigós Ortega, Manuel Martínez Abad
Corresponding author
Servicio de Cirugía General y del Aparato Digestivo, Hospital Doctor Peset, Valencia, Spain
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They are most commonly located in the head, neck and female reproductive organs and are less common in the digestive and biliary tracts. Location in the colon is exceptional, and only 23 cases have been described since 1986.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 59-year-old patient studied by the Gastroenterology Department due to abdominal pain of 3 weeks duration and a palpable mass in the left iliac fossa. The patient had lost approximately 5<span class="elsevierStyleHsp" style=""></span>kg in recent months. On examination, a hard, painful and immobile mass, approximately 10<span class="elsevierStyleHsp" style=""></span>cm in size was palpable in the aforementioned region.</p><p id="par0015" class="elsevierStylePara elsevierViewall">An abdominopelvic CT scan was performed and a 10<span class="elsevierStyleHsp" style=""></span>cm×7<span class="elsevierStyleHsp" style=""></span>cm mass was observed on the sigmoid wall, with exophytic growth, no luminal obstruction and with signs of infiltration of the left anterior rectus abdominis muscle. Two liver lesions suggestive of metastasis were also observed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study was completed by a colonoscopy that showed an irregular, friable mass of approximately 30<span class="elsevierStyleHsp" style=""></span>cm occupying less than 50% of the lumen. Biopsies revealed a fusiform tumour with a high grade of malignancy, which was positive for cytokeratin AE-1, AE-3, CAM 5.2 and vimentin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">For a better characterisation of the tumour, a biopsy of one of the liver lesions was also performed. This confirmed the previous histology and a negative immunoreactivity to: c-kit, desmin, SMA, S-100, CD-34, HMB-45, melan-A, CEA, bcl-2, synaptophysin, GFAP, calretinin and WT-1 was also confirmed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">These results suggested the diagnosis of carcinosarcoma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was scheduled for surgery which revealed a sigmoid mass of 12<span class="elsevierStyleHsp" style=""></span>cm×8<span class="elsevierStyleHsp" style=""></span>cm infiltrating the abdominal wall, two loops of jejunum and the bladder. Because the tumour was locally advanced, the patient underwent palliative surgery with Hartmann's procedure and an R2 resection of the colonic tumour and of the two loops of infiltrated jejunum.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient recovered well from surgery and was discharged one week later. In the three months following surgery the patient showed a significant clinical deterioration. A CT scan was performed, which revealed progression of the liver metastases and the presence of a heterogeneous mass of 18<span class="elsevierStyleHsp" style=""></span>cm×8<span class="elsevierStyleHsp" style=""></span>cm in the lesser pelvis infiltrating the bladder (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Palliative treatment was started but the patient died within days of his fast-growing recurrent pelvic tumour.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Carcinosarcoma is a rare, uncommon disease with a very poor prognosis.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is a type of tumour normally located in the head, neck and female genitourinary system. It is less commonly found in the digestive tract, and the oesophagus, stomach and bile ducts are the affected organs most described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Carcinosarcoma of the colon is extremely rare. The first case was reported in 1986 by Weidner<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and 24 cases have been recorded to date including our patient. Most cases occur in women, especially in the descending and sigmoid colon. Of the cases reported, the vast majority die within a year of diagnosis, with only one patient remaining alive five years after surgery.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The histogenesis of the tumour is not very well defined, although several theories have been proposed. The fact that it presents both epithelial and mesenchymal differentiation has led to it being described as a tumoral transformation of epithelial cells to mesenchymal cells.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It has also been postulated that it is the result of a viral infection which mutates adenocarcinoma to sarcoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, the most solid hypothesis is that the tumour differentiates into two strains from the same cell clone.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The diagnosis of carcinosarcoma of the colon is usually delayed due to a lack of symptoms and therefore the prognosis of this type of tumour is usually poor, and metastatic disease is frequently found at diagnosis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Immunohistochemistry techniques are very important in demonstrating the epithelial nature of the fusiform tumour cells with markers such as cytokeratin and EMA. Other markers such as c-kit, SMA, S-100 and desmine are negative.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The prognosis in the review is very poor; only one patient remained alive at 5 years after diagnosis. Early diagnosis and radical surgery are the most influential factors in terms of survival.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Bertram recommends following the same treatment<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> guidelines as for adenocarcinoma of the colon, although, despite the wide variety of treatment lines applied, no satisfactory results have been obtained.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Peris Tomas N, et al. Carcinosarcoma de colon: a propósito de un caso. Cir Esp. 2013;91:62–3.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1034 "Ancho" => 1500 "Tamanyo" => 165052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the pelvic mass and hepatic metastases despite surgical treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinosarcoma of the colon—report of a unique case with light and immuohistochemical studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. 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Kang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3393/jksc.2010.26.5.368" "Revista" => array:6 [ "tituloSerie" => "J Korean Soc Coloproctol" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "368" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21152142" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence for clorectal sarcomatoid carcinoma arising from tubulovillous adenoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.K. Lee" 1 => "P. Ghosh" 2 => "V. McWohrter" 3 => "M. Payne" 4 => "R. Olson" 5 => "M.L. 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Tietze" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Langenbecks Archiv Chir" "fecha" => "1997" "volumen" => "382" "paginaInicial" => "173" "paginaFinal" => "174" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009100000001/v1_201307111039/S2173507713000021/v1_201307111039/en/main.assets" "Apartado" => array:4 [ "identificador" => "15076" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009100000001/v1_201307111039/S2173507713000021/v1_201307111039/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713000021?idApp=UINPBA00004N" ]
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| 2017 April | 10 | 15 | 25 |
| 2017 March | 12 | 25 | 37 |
| 2017 February | 14 | 0 | 14 |
| 2017 January | 8 | 1 | 9 |
| 2016 December | 8 | 7 | 15 |
| 2016 November | 17 | 3 | 20 |
| 2016 October | 22 | 3 | 25 |
| 2016 September | 19 | 4 | 23 |
| 2016 August | 12 | 6 | 18 |
| 2016 July | 8 | 5 | 13 |
| 2016 June | 17 | 19 | 36 |
| 2016 May | 11 | 10 | 21 |
| 2016 April | 16 | 10 | 26 |
| 2016 March | 24 | 19 | 43 |
| 2016 February | 10 | 11 | 21 |
| 2016 January | 4 | 11 | 15 |
| 2015 December | 17 | 8 | 25 |
| 2015 November | 18 | 4 | 22 |
| 2015 October | 14 | 7 | 21 |
| 2015 September | 25 | 8 | 33 |
| 2015 August | 17 | 9 | 26 |
| 2015 July | 6 | 4 | 10 |
| 2015 June | 7 | 2 | 9 |
| 2015 May | 14 | 5 | 19 |
| 2015 April | 17 | 11 | 28 |
| 2015 March | 16 | 12 | 28 |
| 2015 February | 14 | 4 | 18 |
| 2015 January | 26 | 1 | 27 |
| 2014 December | 37 | 10 | 47 |
| 2014 November | 27 | 7 | 34 |
| 2014 October | 24 | 0 | 24 |
| 2014 September | 26 | 3 | 29 |
| 2014 August | 19 | 4 | 23 |
| 2014 July | 25 | 4 | 29 |
| 2014 June | 17 | 2 | 19 |
| 2014 May | 20 | 2 | 22 |
| 2014 April | 14 | 4 | 18 |
| 2014 March | 14 | 2 | 16 |
| 2014 February | 4 | 0 | 4 |
| 2014 January | 14 | 7 | 21 |
| 2013 December | 20 | 2 | 22 |
| 2013 November | 15 | 4 | 19 |
| 2013 October | 21 | 4 | 25 |
| 2013 September | 13 | 4 | 17 |
| 2013 August | 19 | 2 | 21 |
| 2013 July | 6 | 2 | 8 |
Show all
