Karcinosarkom sigmoidnoga debelog crijeva s mikropapilarnom slikom: prikaz bolesnice [Carcinosarcoma of the sigmoid colon with micropapillary pattern: a case report]

Jukić, Zoran and Ulamec, Monika and Čupić, Hrvoje and Kirac, Petar and Štajduhar, Emil and Krušlin, Božo (2012) Karcinosarkom sigmoidnoga debelog crijeva s mikropapilarnom slikom: prikaz bolesnice [Carcinosarcoma of the sigmoid colon with micropapillary pattern: a case report]. Liječnički vjesnik, 134 (11-12). pp. 318-321. ISSN 0024-3477

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Abstract

Carcinosarcomas are very rare malignant tumors showing both mesenchymal and epithelial differentiation. They most commonly occur in the head and neck region. Few cases were described in the colon associated with very aggressive course. Micropapillary variant is also very rare in the colon and associated with poor prognosis. We report an unusual case of carcinosarcoma of the colon with micropapillary features and psammomatous calcification in an 83-year-old female patient. Tumor was located in the sygmoid colon and measured up to 3.8 cm in the largest diameter. Microscopically it was composed of glandular structures and micropapillary formations with psammomatous calcifications and solid areas built up of spindle cells with focal areas of cartilaginous differentiation. Glandular and micropapillary components immunohistochemically showed positive staining for cytokeratin and EMA while mesenchymal areas were positive for vimentin. The tumor was spreading through the whole thickness of the wall into adjacent fat tissue. Metastases in regional lymph nodes were composed entirely of glandular component. To the best of our knowledge, this is the first case of carcinosarcoma of the colon showing micropapillary features and psammomatous calcification.

Abstract in Croatian

Karcinosarkomi su rijetki maligni tumori s mezenhimalnom i epitelnom diferencijacijom. Najčešće su sijelo glava i vrat, a svega nekoliko slučajeva opisano je u debelom crijevu, s vrlo agresivnim tijekom. Mikropapilarna varijanta karcinoma također vrlo rijetko nastaje u crijevu i povezana je s lošom prognozom. Opisujemo neuobičajeni slučaj karcinosarkoma sigmoidnog kolona s mikropapilarnom diferencijacijom, kod 83-godišnje žene. Tumor je bio promjera do 3,8 cm, mikroskopski se sastojao od žljezdolikih struktura, mikropapilarnih formacija sa psamomskim tjelešcima i solidnih područja koja su uglavnom građena od vretenastih stanica, a žarišno pokazuju hrskavičnu diferencijaciju. Žljezdana i mikropapilarna komponenta imunohistokemijski su pozitivne na epitelni membranski antigen i citokeratin, a mezenhimalna komponenta pozitivna je na vimentin. Tumor je infiltrirao cijelu debljinu stijenke crijeva sa širenjem u okolno masno tkivo. Metastaze u limfnim čvorovima sastojale su se samo od žljezdane komponente. Prema našim saznanjima ovo je prvi takav slučaj opisan u literaturi.

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