Postsurgical radiation therapy for gastric carcinosarcoma with c-kit expression: A case report

Gastric carcinosarcomas are rare morphologically biphasic tumors, consisting of carcinoma and sarcoma components, with a poor clinical course.Here we report the case of a 70-year-old man with advanced Borrmann type Ⅲ carcinosarcoma arising from the upper body of the stomach with extensive lymph node metastasis who underwent a total, but palliative, gastrectomy.Histology showed the tumor consisted of a biphasic structure of tubular adenocarcinoma and spindle cellsarcoma.Immunohistochemistry revealed sarcoma cells expressing c-kit(CD117) and CD34, which are criteria for gastrointestinal stromal tumors.Nine months after the surgical operation, tumor metastases had extended to the hepatohilar, retroperitoneal and mediastinal lymph nodes.Radiation therapy of 50 Gy markedly decreased the size of each of these nodes and reduced the risk of respiratory complications and jaundice.However, the patient died of respiratory failure due to bronchopneumonia with multiple lung metastases 22 mo after resection.Autopsy revealed severe necrosis in most of the lymph nodes with tumor metastases.Radiation therapy combined with gastrectomy should be considered to improve survival in patients with gastric carcinosarcomas that express c-kit.

胃原发性癌肉瘤4例临床病理分析并文献复习

目的:癌肉瘤是指同时具有癌成分和肉瘤成分的恶性肿瘤,恶性程度高,原发胃的癌肉瘤罕见。本文通过探究胃原发性癌肉瘤的临床病理学特征,旨在提高对该肿瘤的认识。方法:回顾性分析苏州大学附属第一医院2017年1月至2023年1月期间收治的胃原发性癌肉瘤4例,并结合相关文献对其临床病理特征、免疫组织化学结果及预后进行总结分析。结果:4例患者中,男3例,女1例。平均年龄为69.8岁。3例因腹痛就诊,1例因持续黑便就诊。肿瘤位于贲门1例,胃底1例,胃窦2例。大体上,肿块呈隆起型,2例为BorrmannⅠ型,2例伴有坏死、为Borrmann II型,平均最大直径为7.1 cm。镜下肿瘤均由明确的癌及肉瘤2种成分组成:癌成分的类型主要有管状腺癌、乳头状腺癌、肝样腺癌及鳞状细胞癌;肉瘤成分有横纹肌肉瘤、梭形细胞未分化肉瘤及多形性未分化肉瘤。2种成分所占比例的差异较大,肉瘤成分占比10%~95%不等。免疫组织化学结果显示癌成分表达细胞角蛋白(cytokeratin,CK)(AE1/AE3),肉瘤成分表达波形蛋白,管状腺癌和乳头状腺癌表达CK7和CK18,鳞状细胞癌表达CK5/6、蛋白(protein,P)63和P40,肝样腺癌表达甲胎蛋白和磷酯酰肌醇蛋白聚糖3(glypican-3)。随访1~36个月,1例术后辅助放射治疗和化学治疗,3例未进行放射治疗和化学治疗,2例分别于术后2、36个月死亡,其余2例生存。结论:胃原发性癌肉瘤罕见,恶性程度高。HE形态结合免疫组织化学可有助于该肿瘤的诊断与鉴别诊断。

胃肝样腺癌6例临床资料分析

[目的]探讨胃肝样腺癌患者的临床表现、治疗以及预后。[方法]回顾性分析6例手术病理证实为胃肝样腺癌患者的临床、病理资料。[结果]6例胃肝样腺癌占医院同期入院胃癌患者的0.4%(6/1 494);1例表现为癌肉瘤,血清甲胎蛋白(AFP)阳性5例,均明显高于正常值上线;3例行根治性手术及化疗,1例行全胃+脾+胰切除及化疗,1例行单纯化疗,1例保守治疗。临床及术后病理提示,6例均有淋巴结转移,其中有2例伴远处转移,术后AFP无明显下降。随访全组患者存活时间2~10个月。[结论]胃肝样腺癌临床表现无明显特异性,病理诊断是其金标准,AFP可用于胃肝样腺癌早期诊断及疗效的判断,部分胃肝样腺癌可以合并肉瘤成分。胃肝样腺癌预后极差,治疗效果欠佳。