A huge adenosquamous carcinoma of the pancreas with sarcomatoid change:An unusual case report

Adenosquamous carcinoma rarely occurs in the pancreas,and is characterized by the presence of cellular components from both duct adenocarcinoma and squamous carcinoma.Here,we describe a rare case of pancreatic adenosquamous carcinoma with sarcomatous change.Immunohistochemistry showed that the sarcomatous lesion lost the epithelial marker and aberrantly expressed of acquired mesenchymal markers,which indicated that this special histological phenotype may be attributed to epithelial-mesenchymal transition.This case also indicated that a routine radical surgery without aggressive treatment strategies was still appropriate for adenosquamous carcinoma of the pancreas with sarcomatoid change.

Extremely rare case of successful treatment of metastatic ovarian undifferentiated carcinoma with high-dose combination cytotoxic chemotherapy: A case report

BACKGROUND Ovarian undifferentiated carcinomas are significantly rare and have an aggressive clinical course.Surgical resection is the only curative treatment in early-stage ovarian undifferentiated carcinomas that has a favorable prognosis.In case of recurrent and metastatic disease,palliative chemotherapy is the only available treatment.However,the effectiveness of standard chemotherapy regimen is not well-known,specifically in the case of extra-ovarian spread.We report an ovarian undifferentiated carcinoma of recurrent and inoperable advanced stage that was successfully treated with high-dose combination chemotherapy.CASE SUMMARY A 52-year-old woman presented with a 1-mo history of right lower quadrant and epigastric pain.A computed tomography(CT)scan of the abdomen revealed a multicystic mass with extensive internal necrosis of the right ovary without evidence of metastatic disease.A total hysterectomy with bilateral salpingooophorectomy and omentectomy was performed,but the surgery had a positive resection margin.Pathologically,it was diagnosed as ovarian undifferentiated carcinoma with sarcomatoid change.Although adjuvant chemotherapy was planned,it was delayed for 6 wk because of postoperative recovery,and the patient complained of abdominal pain.A CT scan and positron emission tomography-CT revealed a huge mass with multiple nodules in the pelvic cavity and para-aortic lymph node metastasis.Instead of standard therapy such as paclitaxel and platinum,combined chemotherapy with etoposide,ifosfamide,and cisplatin was administered.The patient experienced no recurrence for 5 years.CONCLUSION This is a case of metastatic ovarian undifferentiated carcinoma with sarcomatoid change that was successfully treated with high-dose combination cytotoxic chemotherapy.

Prognostic value of clinical and pathological factors for surgically treated localized clear cell renal cell carcinoma

Background Surgical resection is the most effective treatment for renal cell carcinoma （RCC）.Currently several prognostic factors and models are used for outcome prediction.However,whether intratumoral changes are independent prognostic factors for RCC or not remains unclear.The aim of the study was to investigate the prognostic roles of intratumoral changes in surgical treated localized clear cell renal cell carcinoma （ccRCC）.Methods Patients who received partial or radical nephrectomy between 2004 and 2009 in our center were retrospectively reviewed.Univariate and multivariate analyses were used to assess gender,age,body mass index （BMI）,intratumoral hemorrhage,tumor necrosis,cystic degeneration,sarcomatoid change,Ki-67 expression,Fuhrman grade,and T stage on recurrence-free survival （RFS） and cancer-specific survival （CSS）.Results A total of 378 patients were included in our study.In univariate analysis,age,BMI,intratumoral hemorrhage,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade,and T stage were prognostic factors for RFS.Age,BMI,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade,and T stage were prognostic factors effecting CSS.In multivariate analysis,age,BMI,tumor necrosis,sarcomatoid change,Ki-67,Fuhrman grade,and T stage were independent prognostic factors for both RFS and CSS.Conclusion Intratumoral changes such as tumor necrosis and sarcomatoid change are independent prognostic factors for ccRCC.