Bloomston Mark, Chanona-Vilchis Jose, Ellison E Christopher, Ramirez Nilsa C, Frankel Wendy L
Department of Pathology, The Ohio State University, E-401 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
Am Surg. 2006 Apr;72(4):351-5.
We report a carcinosarcoma of the pancreas in a 67-year-old woman who presented with nausea, vomiting, and painless jaundice. A work-up demonstrated a well-circumscribed mass in the head of the pancreas. After pylorus-preserving pancreaticoduodenectomy, the tumor was found to be grossly yellow, and it compressed the common bile duct and pancreatic duct. Histological examination of the neoplasm showed a 4.0 x 4.0 x 3.0-cm mucinous cystadenocarcinoma with invasive poorly differentiated carcinoma, well-differentiated squamous cell carcinoma, and sarcomatous stroma invading into the duodenum. There was no evidence of nodal metastasis (pT3N0M0). Immunohistochemical studies showed that the epithelial cells stained positive for cytokeratin 7, cytokeratin AE1/3, cytokeratin monoclonal antibody 5.2, epithelial membrane antigen, M-carcinoembryonic antigen, and low-molecular-weight kininogen, and the sarcomatous component was immunoreactive with vimentin. The patient had an uneventful recovery, but died 4 months later of rapidly progressive metastatic disease to the liver and peritoneum. To the best of our knowledge, this is the second case of carcinosarcoma with invasive epithelial and sarcomatous areas in the background of a mucinous cystic neoplasm of the pancreas.
我们报告了一名67岁女性的胰腺癌肉瘤病例，该患者出现恶心、呕吐和无痛性黄疸。检查发现胰腺头部有一个边界清晰的肿块。在保留幽门的胰十二指肠切除术后，发现肿瘤大体呈黄色，压迫胆总管和胰管。肿瘤的组织学检查显示为一个4.0×4.0×3.0厘米的黏液性囊腺癌，伴有浸润性低分化癌、高分化鳞状细胞癌和肉瘤样间质侵入十二指肠。无淋巴结转移证据（pT3N0M0）。免疫组织化学研究表明，上皮细胞细胞角蛋白7、细胞角蛋白AE1/3、细胞角蛋白单克隆抗体5.2、上皮膜抗原、M-癌胚抗原和低分子量激肽原染色呈阳性，肉瘤样成分波形蛋白免疫反应阳性。患者恢复顺利，但4个月后死于迅速进展的肝和腹膜转移癌。据我们所知，这是第二例在胰腺黏液性囊性肿瘤背景下具有浸润性上皮和肉瘤样区域的癌肉瘤病例。
