Selcukbiricik Fatih, Tural Deniz, Senel Elif Tuba, Dervisoglu Sergülen, Serdengecti Süheyla
Istanbul University, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Medical Oncology, TR-34098 Istanbul, Turkey.
Int J Surg Case Rep. 2012;3(11):516-9. doi: 10.1016/j.ijscr.2012.07.001. Epub 2012 Jul 20.
Carcinosarcoma is a rare malignant biphasic tumor which has sarcomatous and carcinomatous components. Stomach localization is very rare. We discuss the diagnosis, follow-up and treatment of patients diagnosed with gastric carcinosarcoma in company with the literature review.
A 73-year-old white male patient applied to hospital with dyspeptic complaints lasting for 2months. His endoscopic examination revealed an ulcero-vegetating mass in the cardiac region of his stomach. Total gastrectomy and D2 lymph node dissection were performed for the patient. In the pathologic evaluation, the tumor was found consistent with Stage IIA stomach adenocarcinoma in accordance with AJCC (7edt, 2010) classification. Pathologic specimen was reevaluated by an expert pathologist for the patient with progression and liver metastasis under adjuvant chemotherapy and concomitant radiotherapy. The new pathology was consistent with gastric carcinosarcoma, and 90% of the tumor was identified as osteosarcoma whereas 10% was identified as carcinoma. Cisplatin doxorubicine-based chemotherapy was given considering the fact that sarcomatous component was dominant.(1) The patient was given 3 courses of chemotherapy. However, as the patient showed progression under therapy, he died after 14months of the diagnosis.
Gastric carcinosarcoma is a very rare and clinically aggressive malignancy. Recurrence is likely to occur with a rate of more than 50% in patients who have undergone resection within the first year following surgery, and overall survival time is 10-15months.
In refractory gastric carcinoma cases with rapid progression, we suggest that gastric carcinosarcoma with biphasic component should be taken into consideration and the pathological evaluation should be performed by an expert pathologist.
癌肉瘤是一种罕见的恶性双相肿瘤，具有肉瘤和癌的成分。胃部定位非常罕见。我们结合文献综述，讨论了诊断为胃癌肉瘤患者的诊断、随访及治疗。
一名73岁的白人男性患者因持续2个月的消化不良症状入院。他的内镜检查显示胃贲门区有一个溃疡型肿物。为该患者实施了全胃切除术及D2淋巴结清扫术。病理评估显示，根据美国癌症联合委员会（AJCC，第7版，2010年）分类，该肿瘤符合IIA期胃腺癌。病理标本由一名专家病理学家对在辅助化疗和同步放疗下病情进展且出现肝转移的患者进行了重新评估。新的病理结果符合胃癌肉瘤，肿瘤的90%被鉴定为骨肉瘤，而10%为癌。鉴于肉瘤成分占主导，给予了基于顺铂和阿霉素的化疗。（1）该患者接受了3个疗程的化疗。然而，由于患者在治疗过程中病情进展，确诊14个月后死亡。
胃癌肉瘤是一种非常罕见且临床侵袭性强的恶性肿瘤。术后第一年接受手术切除的患者复发率可能超过50%，总生存时间为10 - 15个月。
对于进展迅速的难治性胃癌病例，我们建议应考虑到具有双相成分的胃癌肉瘤，并由专家病理学家进行病理评估。
