Yepuri Natesh, Pruekprasert Napat, Naous Rana
Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
AME Case Rep. 2018 Aug 22;2:39. doi: 10.21037/acr.2018.08.02. eCollection 2018.
Sarcomatoid carcinoma is a rare and aggressive form that occur at diverse locations in the body such as upper respiratory tract, upper and lower digestive tracts, genitourinary tract, breast and thyroid glands. However, its occurrence in pancreas has been rarely reported. Sarcomatoid carcinoma of pancreas (SCP) is a high-grade epithelial malignancy composed predominantly of spindle cells often having features suggestive of epithelial derivation without features indicative of a specific line of mesenchymal differentiation. Its pathogenesis has not been elucidated. Microscopically, SCP comprises mostly anaplastic cells and is strikingly sarcoma-like in appearance. Confirmation of this disease is often based on the pathological diagnosis. We report a case that was incidentally found after a CT was done for worsening chronic back pain and the patient was found to have a pancreatic mass and a liver lesion. Endoscopic ultrasound (EUS)-guided liver biopsy revealed high grade malignant pancreatic neoplasm with sarcomatoid features. Further CT chest revealed bilateral lung nodules and PET scan revealed prominent bony metastases within vertebral bodies at L1, L2, and L3. The patient refused definitive treatment and succumbed to illness within 3 months.
肉瘤样癌是一种罕见且侵袭性强的癌症，可发生于身体的不同部位，如呼吸道上段、上消化道和下消化道、泌尿生殖道、乳腺及甲状腺。然而，其在胰腺中的发生情况鲜有报道。胰腺肉瘤样癌（SCP）是一种高级别上皮性恶性肿瘤，主要由梭形细胞组成，这些细胞通常具有提示上皮来源的特征，而无提示特定间充质分化谱系的特征。其发病机制尚未阐明。显微镜下，SCP主要由间变细胞组成，外观上与肉瘤极为相似。该病的确诊通常基于病理诊断。我们报告一例因慢性背痛加重行CT检查时偶然发现的病例，该患者被发现有胰腺肿块和肝脏病变。内镜超声（EUS）引导下的肝脏活检显示为具有肉瘤样特征的高级别恶性胰腺肿瘤。进一步的胸部CT显示双侧肺结节，PET扫描显示L1、L2和L3椎体有明显的骨转移。患者拒绝确定性治疗，3个月内病逝。
