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Carcinosarcoma of the Rectum: Report of a Rare Colorectal Malignancy and Review of the Literature.

Sudlow A, Liu MH, Waters G, Velchuru VR - Case Rep Surg (2015)

Bottom Line: Histologically, it is composed of two distinct elements of epithelial and mesenchymal origin.Prognosis is poor despite intervention with the majority of patients dying within six months.Due to the rarity of this condition, there are no specific treatment guidelines presently available.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, James Paget University Hospital, Gorleston NR31 6LA, UK.

ABSTRACT
Carcinosarcoma (CS) is a rare mixed mesodermal malignancy most commonly affecting the female reproductive organs, respiratory tract, head, and neck. Though infrequent, it may affect the gastrointestinal tract, most often the oesophagus and only very rarely the rectum. Histologically, it is composed of two distinct elements of epithelial and mesenchymal origin. Clinically, it is a very aggressive tumour with many patients presenting with metastatic lymph nodes or distant metastases at the time of diagnosis. Prognosis is poor despite intervention with the majority of patients dying within six months. Due to the rarity of this condition, there are no specific treatment guidelines presently available. We describe the case of an 80-year-old patient with carcinosarcoma of the rectum with discussion of the immunohistochemistry and review the available literature pertaining to this rare presentation.

No MeSH data available.


Related in: MedlinePlus

Staging MRI demonstrating low rectal mass, invading potential anterior resection margin.
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Related In: Results  -  Collection


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fig1: Staging MRI demonstrating low rectal mass, invading potential anterior resection margin.

Mentions: An 80-year-old female presented with a four-week history of fresh rectal bleeding, associated with poor appetite and weight loss. There were no other symptoms relating to change in bowel habit. Past medical history included ischemic heart disease, atrial fibrillation, hypertension, Parkinson's disease, and hysterectomy several years previously for benign disease. Abdominal examination was unremarkable; however, a low rectal tumour was palpated anteriorly on digital rectal examination. Subsequent colonoscopy showed a large solitary polypoidal growth in the lower rectum. Biopsy of the lesion provided a histological diagnosis of CS based on the presence of two clearly identifiable components on HPE. The tumour consisted of malignant glands set within an atypical stroma consisting of fascicles of spindle cells with thin, oval tapered nuclei and eosinophilic cytoplasm with perinuclear vacuolation. The stromal spindle cells showed florid mitotic activity. Further immunostaining confirmed the nature of the two components with the glandular tissue staining positively for CK20 and CEA. The stromal component did not stain positively for epithelial markers and was negative for cytokeratins. Staging computed tomography (CT) scan of the chest, abdomen, and pelvis and pelvic magnetic resonance imaging (MRI) were performed (Figure 1). A low rectal tumour at 4.2 cm from the dentate line was seen with extramural invasion to the potential anterior resection margin. Three suspicious lymph nodes were noted and the radiological staging was T3 N1 M0.


Carcinosarcoma of the Rectum: Report of a Rare Colorectal Malignancy and Review of the Literature.

Sudlow A, Liu MH, Waters G, Velchuru VR - Case Rep Surg (2015)

Staging MRI demonstrating low rectal mass, invading potential anterior resection margin.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4664799&req=5

fig1: Staging MRI demonstrating low rectal mass, invading potential anterior resection margin.
Mentions: An 80-year-old female presented with a four-week history of fresh rectal bleeding, associated with poor appetite and weight loss. There were no other symptoms relating to change in bowel habit. Past medical history included ischemic heart disease, atrial fibrillation, hypertension, Parkinson's disease, and hysterectomy several years previously for benign disease. Abdominal examination was unremarkable; however, a low rectal tumour was palpated anteriorly on digital rectal examination. Subsequent colonoscopy showed a large solitary polypoidal growth in the lower rectum. Biopsy of the lesion provided a histological diagnosis of CS based on the presence of two clearly identifiable components on HPE. The tumour consisted of malignant glands set within an atypical stroma consisting of fascicles of spindle cells with thin, oval tapered nuclei and eosinophilic cytoplasm with perinuclear vacuolation. The stromal spindle cells showed florid mitotic activity. Further immunostaining confirmed the nature of the two components with the glandular tissue staining positively for CK20 and CEA. The stromal component did not stain positively for epithelial markers and was negative for cytokeratins. Staging computed tomography (CT) scan of the chest, abdomen, and pelvis and pelvic magnetic resonance imaging (MRI) were performed (Figure 1). A low rectal tumour at 4.2 cm from the dentate line was seen with extramural invasion to the potential anterior resection margin. Three suspicious lymph nodes were noted and the radiological staging was T3 N1 M0.

Bottom Line: Histologically, it is composed of two distinct elements of epithelial and mesenchymal origin.Prognosis is poor despite intervention with the majority of patients dying within six months.Due to the rarity of this condition, there are no specific treatment guidelines presently available.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, James Paget University Hospital, Gorleston NR31 6LA, UK.

ABSTRACT
Carcinosarcoma (CS) is a rare mixed mesodermal malignancy most commonly affecting the female reproductive organs, respiratory tract, head, and neck. Though infrequent, it may affect the gastrointestinal tract, most often the oesophagus and only very rarely the rectum. Histologically, it is composed of two distinct elements of epithelial and mesenchymal origin. Clinically, it is a very aggressive tumour with many patients presenting with metastatic lymph nodes or distant metastases at the time of diagnosis. Prognosis is poor despite intervention with the majority of patients dying within six months. Due to the rarity of this condition, there are no specific treatment guidelines presently available. We describe the case of an 80-year-old patient with carcinosarcoma of the rectum with discussion of the immunohistochemistry and review the available literature pertaining to this rare presentation.

No MeSH data available.


Related in: MedlinePlus