Suzuki J, Takagi M, Okada N, Hatakeyama S, Yamamoto H
Department of Oral Pathology, Faculty of Dentistry, Tokyo Medical and Dental University, Japan.
Acta Pathol Jpn. 1990 Nov;40(11):827-31. doi: 10.1111/j.1440-1827.1990.tb02496.x.
We present a rare case of submandibular gland carcinosarcoma occurring in a 45-year-old male patient. His clinical history revealed that the carcinosarcoma had developed from a carcinoma ex mixed tumor in three years. In spite of repeated resection, intensive chemotherapy and irradiation, the tumor recurred and grew rapidly, and the patient died of hemothorax caused by rupture of a pulmonary metastatic tumor. The fourth recurrent tumor and autopsy specimens showed features of carcinosarcoma consisting of three tumor components, i.e., undifferentiated carcinoma, and chondrosarcomatous and osteosarcomatous growth. The metastatic nodules in both lungs and pulmonary hilar lymph nodes showed the same pattern. Immunohistochemically, the chondrosarcomatous cells were positive for vimentin and S-100 protein, and for epithelial markers such as epithelial membrane antigen (EMA) and cytokeratin (MA-902). Undifferentiated carcinoma cells, on the other hand, were partially positive for muscle actin other than cytokeratin (KL 1). Ultrastructurally, desmosome-like structures were seen in the chondrosarcomatous cells. These findings suggest that the sarcomatous lesions might have originated from epithelial cells.
我们报告一例罕见的发生于一名45岁男性患者的颌下腺癌肉瘤。他的临床病史显示，癌肉瘤由混合瘤恶变而来，病程为三年。尽管进行了多次手术切除、强化化疗和放疗，肿瘤仍复发且生长迅速，患者最终死于肺转移瘤破裂导致的血胸。第四次复发肿瘤及尸检标本显示癌肉瘤具有三种肿瘤成分的特征，即未分化癌、软骨肉瘤样生长和骨肉瘤样生长。双肺及肺门淋巴结的转移结节呈现相同的模式。免疫组化显示，软骨肉瘤样细胞波形蛋白和S-100蛋白阳性，同时也表达上皮标记物，如上皮膜抗原（EMA）和细胞角蛋白（MA-902）。另一方面，未分化癌细胞除细胞角蛋白（KL 1）外，肌动蛋白也呈部分阳性。超微结构观察发现，软骨肉瘤样细胞中有类似桥粒的结构。这些发现提示肉瘤样病变可能起源于上皮细胞。
