A Rare Case of Borderline Resectable Carcinosarcoma
Context Carcinosarcomas are neoplasms with mixed carcinomatous and sarcomatous elements, which rarely occur in the pancreas. Case report A 62-year-old man was admitted to our institute for the presence of intense abdominal pain, worsening of a type II diabetes and weight loss (10 kg in 3 months). The tumor markers (CEA, CA 19-9) were within normal range. A CT scan showed a large pancreatic head solid mass of about 5 cm in diameter, with central necrotic area with septa, peripheral contrast-enhancement and compression and dislocation of the superior mesenteric vein for a tract of 2.5 cm (G3). An US-guided percutaneous biopsy diagnosed a malignant, high grade spindle cells neoplasia with immunophenotypic pattern of sarcomas. Surgical approach was planned and a total pancreatectomy with vascular resection was performed. The vascular resection included a 8 cm tract of portal-mesenteric trunk and the reconstruction was performed using a donor’s femoral vein homograft. Pathological examination of the specimen showed a solid mass of 6 cm in diameter, with infiltration of the portal vein. Lymph nodes (n=48) were negative and the surgical margins were tumor-free. Microscopically the tumor was characterized by high grade, polymorphous, intensely desmin-positive spindle cells mixed with areas of moderately differentiated ductal adenocarcinoma. The remaining pancreatic gland was interested by a diffuse lympho-plasmacellular GEL-type acute pancreatitis. A final diagnosis of carcinosarcoma, pT3N0M0, was performed. The postoperative course was uneventful and the patient was discharged in post-operative day 14th. He is dead, 4 months after surgery. Conclusion In literature only 10 cases of pancreatic carcinosarcomas have been described All cases were treated surgically and they showed a poor prognosis (average 6 months) and a rapid recurrence of the disease as in our case.
Copyright (c) 2014 Giovanni Taffurelli, Marielda D’Ambra, Carlo Alberto Pacilio, Salvatore Buscemi, Eugenia Peri, Claudio Ricci, Donatella Santini, Raffaele Pezzilli, Riccardo Casadei, Francesco Minni
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