Journal of Pathology and Translational Medicine

Case Study

Fine-Needle Aspiration Cytology of Carcinosarcoma in the Salivary Gland: An Extremely Rare Case Report: Hyo Jung An, Hye Jin Baek, Jin Pyeong Kim, Min Hye Kim, Dae Hyun Song; J Pathol Transl Med. 2018;52(2):136-139. Published online December 28, 2017; DOI: https://doi.org/10.4132/jptm.2017.07.27

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Carcinosarcoma of the salivary gland is an extremely rare tumor that is composed of both malignant epithelial and mesenchymal components. Diagnosing carcinosarcoma with fine-needle aspiration cytology is challenging because of its overlapping cytomorphologic characteristics with other high-grade malignant salivary gland tumors. Among the many features, including pleomorphic oncocytoid epithelial components, necrotic background, and mitoses, recognizing the singly scattered atypical spindle cells is most essential in carcinosarcoma. We present a case of a 66-year-old male patient with characteristic features of carcinosarcoma, who was successfully treated by wide local excision and subsequent radiation therapy.

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Carcinosarcoma of the parotid gland: a case report and review of the literature
Swachi Jain, Mohammed Abdelwahed, Daniel Hector Chavarria, Lucio Pereira, Gary Stone, Alan Johnson, Jian Yi Li
Journal of Medical Case Reports.2024;[Epub] CrossRef
Is Primary Poorly Differentiated Sarcomatoid Malignancy of the Parotid Gland Sarcomatoid Undifferentiated/Dedifferentiated Melanoma? Report of Three Unusual Cases Diagnosed by Fine-Needle Aspiration Combined with Histological, Immunohistochemical, and Mol
Jerzy Klijanienko, Julien Masliah-Planchon, Olivier Choussy, Guillaume Rougier, Antoine Dubray Vautrin, Maria Lesnik, Nathalie Badois, Wahib Ghanem, Jan Klos, Christophe Le Tourneau, Gregoire Marret, Raymond Barnhill, Adel K. El-Naggar
Acta Cytologica.2024; : 1. CrossRef
Carcinosarcoma of the deep lobe of the parotid gland in the parapharyngeal region: A case report
Yue-Yang Tang, Gui-Quan Zhu, Zhi-Jian Zheng, Li-Hong Yao, Zi-Xin Wan, Xin-Hua Liang, Ya-Ling Tang
World Journal of Clinical Cases.2023; 11(31): 7663. CrossRef
Carcinosarcoma of Submandibular Salivary Gland with a Rare Sarcomatous Variant
Shalini Bhalla, Naseem Akhtar, Puneet Prakash, Malti Kumari, Madhu Mati Goel
Indian Journal of Surgical Oncology.2019; 10(1): 61. CrossRef

Brief Case Report

Indolent CD56-Positive Clonal T-Cell Lymphoproliferative Disease of the Stomach Mimicking Lymphomatoid Gastropathy: Mineui Hong, Won Seog Kim, Young Hyeh Ko; Korean J Pathol. 2014;48(6):430-433. Published online December 31, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.430

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Case Report: Primary Indolent Epstein-Barr Virus-Positive T-Cell Lymphoproliferative Disease Involving the Central Nervous System
Kun Wang, Jinjian Li, Xuehui Zhou, Junhui Lv, Yirong Wang, Xinwei Li
Frontiers in Surgery.2022;[Epub] CrossRef
Indolent NK cell proliferative lesion mimicking NK/T cell lymphoma in the gallbladder
Su Hyun Hwang, Joon Seong Park, Seong Hyun Jeong, Hyunee Yim, Jae Ho Han
Human Pathology: Case Reports.2016; 5: 39. CrossRef

Case Reports

Metaplastic Thymoma: Report of 4 Cases: Guhyun Kang, Nara Yoon, Joungho Han, Young Eun Kim, Tae Sung Kim, Kwhanmien Kim; Korean J Pathol. 2012;46(1):92-95. Published online February 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.1.92

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Abstract PDF

Metaplastic thymoma (MT), accepted in the World Health Organization 2004 scheme, is a circumscribed tumor of the thymus exhibiting biphasic morphology. We herein describe the clinicopathologic features of four MTs and the differential diagnoses of this unusual tumor. There were three women and one man with mean age of 49.5 years. The patients were found to have mediastinal masses, and underwent surgical excision. One exhibited symptoms of myasthenia gravis, and the serum titer for anti-acetylcholine receptor antibody was positive. Grossly, the tumors were encapsulated, and showed vaguely multinodular, solid, tan-white to yellow cut surfaces. Histologically, they comprised epithelial islands intertwining with bundles of delicate spindle cells. The patients remained well after surgical excision at 5-55 months. Because of the distinctive histological appearance and benign clinical course, MT should be distinguished from other more aggressive mediastinal neoplasms displaying biphasic feature.

Citations

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A Rare Case of Metaplastic Thymoma Presenting With Myasthenia Gravis
Ilianne Vega Prado, John Shymansky, Anisha Apte, Keith Mortman, Henry J. Kaminski, Stephanie Barak
International Journal of Surgical Pathology.2024; 32(1): 155. CrossRef
Thymic epithelial tumours: histopathological classification and differential diagnosis
Jan von der Thüsen
Histopathology.2024; 84(1): 196. CrossRef
Epigenetics of Thymic Epithelial Tumors
Vanessa Nicolì, Fabio Coppedè
Cancers.2023; 15(2): 360. CrossRef
Expanding the Clinicopathologic Spectrum of YAP1::MAML2–Rearranged Thymic Neoplasm
Eric Eunshik Kim, Ye Yoon Suh, Sang Won Lee, Jeong Mo Bae, Kyoungbun Lee, Sungyoung Lee, Hongseok Yun, Kyeong Cheon Jung, Jiwon Koh
Modern Pathology.2023; 36(2): 100048. CrossRef
Significance of YAP1–MAML2 rearrangement and GTF2I mutation in the diagnosis and differential diagnosis of metaplastic thymoma
Minghao Wang, Hongtao Xu, Qiang Han, Liang Wang
Annals of Medicine.2023;[Epub] CrossRef
Loss of YAP1 C‐terminus expression as an ancillary marker for metaplastic thymoma: a potential pitfall in detecting YAP1::MAML2 gene rearrangement
Xuan Wang, Lei‐lei Liu, Qing Li, Qiu‐yuan Xia, Rui Li, Sheng‐bing Ye, Ru‐song Zhang, Ru Fang, Hui Chen, Nan Wu, Qiu Rao
Histopathology.2023; 83(5): 798. CrossRef
A Case of Metaplastic Thymoma
Ryoichi TAKENAKA, Kenji NEZU, Daijiro TAKEMOTO, Tatsuya HAYASHI, Hisato YAMAMOTO, Shoichi MATSUKAGE
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2023; 84(4): 538. CrossRef
Malignant Transformation of Metaplastic Thymoma into High-Grade Sarcomatoid Carcinoma: A Case Report
Zheng Hua Piao, Jin Ping Chen, Hai Ren Chen, Xin Cheng Zhou
International Journal of Surgical Pathology.2022; 30(5): 564. CrossRef
YAP1-MAML2 Fusion as a Diagnostic Biomarker for Metaplastic Thymoma
Jikai Zhao, Ruiying Zhao, Chan Xiang, Jinchen Shao, Lianying Guo, Yuchen Han
Frontiers in Oncology.2021;[Epub] CrossRef
Metaplastic thymoma: a distinctive thymic neoplasm characterized by YAP1-MAML2 gene fusions
Marina Vivero, Phani Davineni, Valentina Nardi, John K.C. Chan, Lynette M. Sholl
Modern Pathology.2020; 33(4): 560. CrossRef
Metaplastic thymoma: Report of two cases
Yoshikazu Shinohara, Mariko Tanaka, Kentaro Kitano, Kazuhiro Nagayama, Masaaki Sato, Jun Nakajima
The Journal of the Japanese Association for Chest Surgery.2020; 34(7): 733. CrossRef
Type AB thymoma is not a mixed tumor of type A and type B thymomas, but a distinct type of thymoma
Yukari Miki, Kana Hamada, Tadashi Yoshino, Katsuya Miyatani, Kiyoshi Takahashi
Virchows Archiv.2014; 464(6): 725. CrossRef
Potential Role of Adjuvant Radiation Therapy in Cervical Thymic Neoplasm Involving Thyroid Gland or Neck
Jae Myoung Noh, Sang Yun Ha, Yong Chan Ahn, Dongryul Oh, Seung Won Seol, Young Lyun Oh, Joungho Han
Cancer Research and Treatment.2014; 47(3): 436. CrossRef
A Case of Metaplastic Thymoma
Eiji MIYAHARA, Tomoko ITAGAKI, Masaki KUWAHARA, Akira KAMEDA, Yoshihiro MIYATA, Kazuhiro SENTANI, Wataru YASUI
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2014; 75(2): 360. CrossRef

Parotid Gland Carcinosarcoma with Osteosarcoma as a Sarcomatous Component: A Case Report with Fine Needle Aspiration Cytologic Findings.: Se Min Jang, Young Jin Jun, Hulin Han, Ki Seok Jang, Seung Sam Paik; Korean J Pathol. 2011;45(4):412-416.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.4.412

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Abstract PDF

Carcinosarcoma of the salivary glands is a rare malignant tumor showing both malignant epithelial and mesenchymal components. Herein, we present a carcinosarcoma of the parotid gland in a 67-year-old man consisting of osteosarcoma and adenocarcinoma components with fine needle aspiration cytological findings. The tumor was composed predominantly of osteosarcoma and small areas of adenocarcinomatous components and a hyalinized nodule reminiscent of pleomorphic adenoma. The tumor showed infiltrative growth features with perineural, lymphatic, and vascular invasion. Despite postoperative adjuvant radiation therapy, multiple metastatic lesions occurred in the both lungs 5 months after surgery. As salivary gland carcinosarcoma has been known to demonstrate highly aggressive behavior, an accurate pathological diagnosis is prerequisite for appropriate treatment.

Citations

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Carcinosarcoma of the parotid gland with abdominal metastasis: a case report and review of literature
Chang Gok Woo, Seung-Myoung Son
World Journal of Surgical Oncology.2018;[Epub] CrossRef

A Metastatic Granulocyte Colony-Stimulating Factor Producing Sarcomatoid Carcinoma of the Lung Causing Jejunal Intussusception: Report of a Case.: Min Eui Hong, Soon Auck Hong, Gui Young Kwon, Tae Jin Lee, Eon Sub Park, Sung Jae Cha, Jae Hyuk Do, Jae Hyung Yoo; Korean J Pathol. 2011;45(2):205-208.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.2.205

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Abstract PDF: A 75-year-old man was referred to our hospital with intestinal obstruction caused by intussusception. Abdominal computed tomography (CT) revealed seven polypoid masses in the small intestine, while chest CT revealed a mass in the right lower lobe. Preoperative laboratory tests showed white blood cell (WBC) and neutrophil differential counts of 63,630/mm3 and 95%, respectively. The serum granulocyte colony-stimulating factor (G-CSF) was 114 pg/mL, which was elevated (normal range, <18.1 pg/mL). After resection of the small bowel, the WBC count decreased to 20,510/mm3. The pathology showed a poorly differentiated carcinoma with sarcomatous components confirmed by positive immunostaining of cytokeratin (AE1/AE3) and vimentin in the small intestine. Furthermore, immunohistochemistry with specific monoclonal antibodies against G-CSF was positive. A lung biopsy revealed the same histological findings as the small intestine lesion. Therefore, the patient was diagnosed as having a G-CSF producing sarcomatoid carcinoma of the lung with metastasis to the small intestine.

A Case of Gastric Carcinosarcoma with Neuroendocrine and Smooth Muscle Differentiation.: Se Min Jang, Si Hyong Jang, Kyueng Whan Min, Woong Na, Young Jin Jun, Seung Sam Paik; Korean J Pathol. 2010;44(1):87-91.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.87

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Abstract PDF

Carcinosarcoma of the stomach is a rarely occurring malignant biphasic tumor that consists of both carcinomatous and sarcomatous components simultaneously in a single tumor. The common carcinoma component is tubular or papillary adenocarcinoma and the mesenchymal sarcomatous components are variable and these include leiomyosarcoma, rhabdomyosarcoma, osteosarcoma and chondrosarcoma. However, neuroendocrine carcinomatous differentiation in the carcinomatous component is extremely rare. We present here a rare gastric carcinosarcoma that demonstrated neuroendocrine carcinomatous and leiomyosarcomatous differentiation in a 47-year-old man.

Citations

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Asymptomatic giant gastric carcinosarcoma
Hitesh Sarda, Anshuman Pandey, Abhishek Gatuam, Hareesh Shanthappa Nellikoppad
BMJ Case Reports.2023; 16(10): e255680. CrossRef
Carcinosarcoma of Stomach Confined to the Mucosa
Hirohiko Kuroda, Hiroaki Saito, Yusuke Kono, Yuki Murakami, Yuji Shishido, Tomoyuki Matsunaga, Yoji Fukumoto, Tomohiro Osaki, Keigo Ashida, Kanae Nosaka, Yoshihisa Umekita, Yoshiyuki Fujiwara
Yonago Acta Medica.2017; 60(4): 246. CrossRef
A Rare Case of Gastric Carcinosarcoma with Neuroendocrine Differentiation
Hae Jin Shin, Jong Seok Ju, Hee Seok Moon, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong, Kyu Sang Song
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014; 14(2): 121. CrossRef
Gastric Sarcomatoid Carcinoma
Fabio Carboni, Giovanni Battista Levi Sandri, Mario Valle, Renato Covello, Alfredo Garofalo
Journal of Gastrointestinal Surgery.2013; 17(11): 2025. CrossRef
Gastric carcinosarcoma: A case report and review of the literature
ROBERTO CIROCCHI, STEFANO TRASTULLI, JACOPO DESIDERIO, VERONICA GRASSI, IVAN BARILLARO, ALBERTO SANTORO, CARLO BOSELLI, NICOLA AVENIA, GIUSEPPE NOYA, ANGELO DE SOL
Oncology Letters.2012; 4(1): 53. CrossRef

Coexisting Adenocarcinoma and Epithelioid Leiomyosarcoma of Stomach: A case report.: Jung Youn Kim, Jae Soo Koh, Kyung Ja Cho, Ja June Jang; Korean J Pathol. 1995;29(4):521-523.

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Abstract PDF: We report a case of malignant tumor of the stomach showing both carcinoma and sarcoma components in a 47 year-old woman. The resected stomach revealed two tumors which were in different location. The one mass was a 2 x I cm, poorly demarcated tumor at the body, along the lesser curvature and the other was a 6 x 7 cm, well demarcated polypoid tumor with a central depression at cardia of the posterior stomach wall. The tumor at the body was a poorly differentiated adenocarcinoma which showed strong reactivity for CEA. The tumor at the cardia was composed of epithelioid or spindle shaped cells with abundant eosinophilic cytoplasm and revealed 5-6 mitoses per ten high power field. The tumor at the cardia was diagnosed as epithelioid leiomyosarcoma and showed reactivity for vimentin but none for actin, desmin,keratin, and CEA. This is different from the usual carcinosarcoma.

Carcinosarcoma and Multiple Early Gastric Carcinomas of the Stomach.: Won Mee Lee, Young Ha Oh, Moon Hyang Park, Kwang Su Lee, Jung Dal Lee; Korean J Pathol. 1997;31(3):252-256.

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Abstract PDF: We report a rare case of carcinosarcoma arising in the stomach. The tumor is presented in the posterior wall of the gastric lower body and antrum of a 56-year-old man. Grossly the tumor has polypoid appearance with diffuse surface ulceration and measures 5.5 cm in diameter. The tumor is accompanied with three separate well differentiated early gastric adenocarcinomas (two EGC type IIc & IIa). Microscopically, the tumor consists of moderately well differentiated adenocarcinoma in the periphery, and lobulated sarcomatous areas in the center, which shows chondroid differentiation. Transitional areas between adenocarcinoma and chondrosarcoma are evident. Immunohistochemical studies show positivity for cytokeratin and carcinoembryonic antigen in the epithelial component, and for vimentin and S-100 in the sarcomatous component. The transitional areas are positive in carcinoembryonic antigen, vimentin, S-100, and cytokeratin. The tumor extended to the subserosa and showed metastasis of only adenocarcinomatous component in six out of 47 dissected perigastric lymph nodes.

Original Articles

Carcinosarcoma (Malignant M llerian Mixed Tumor) of the Female Genital Tract: A clinical and pathologic study of ten carcinosarcomas.: Sung Ran Hong, Yee Jeong Kim, Hy Sook Kim, Jae Uk Shim, Chong Taik Park; Korean J Pathol. 1998;32(5):362-369.

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Abstract: Carcinosarcomas of the female genital tract have generally been regarded as a type of sarcoma. Recent studies, however, suggest the tumor may be more closely related to carcinoma and may represent metaplastic carcinoma in histogenesis. We analyzed clinicopathologic and immunohistochemical features of 10 carcinosarcomas to evaluate the relative importance of the carcinomatous and sarcomatous components in metastasis and recurrence. The primary tumor originated in the uterine body in seven cases, the uterine cervix in two and the ovary in one. Patient,s ages ranged from 54 to 71 years (mean, 64). The most common symptom of the uterine mass was vaginal bleeding. The median survival time was 21 months following diagnosis in five cases. Surgico-pathologic FIGO stages of five patients who received an operation were stage III and IV, but clinical FIGO stage of three patients (60%) among them were I. Lymphovascular invasions were identified in seven areas; five vascular invasion lesions showed the carcinomatous component alone, one the sarcomatous component alone, and remained one admixture of both components. Metastatic and recurrent lesions to the paraaortic lymph node, ovary, pelvic wall, or vaginal vault showed characteristically carcinomatous component only. Immunohistochemically, positive reactions for cytokeratin and epithelial membrane antigen were noted in the sarcomatous component of five cases. Vimentin positivity was detected in carcinomatous component of three cases. We conclude that the dominant element in carcinosarcomas of the female genital tract is the carcinomatous component. The survival rate of carcinosarcoma is extremely poor. The surgico-pathologic stage is better indicator of survival than the clinical stage. Immunohistochemical findings suggest that carcinosarcoma may represent a metaplastic carcinoma in histogenesis.

Carcinosarcoma of the Female Genital Tract: Immunohistochemical study on transitional area further supports the metaplastic origin.: Chan Pil Park, Joo Seob Keum, Gu Kong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(5):370-377.

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Abstract: Carcinosarcoma of the female genital tract, also called malignant mixed mullerian tumor (MMMT), is a rare and relatively aggressive tumor with various homologous and heterologous components. There have been various studies to find prognostic factors and to investigate the histogenesis, including tissue culture, electron microscopy, and immunohistochemical studies. We investigated carcinomatous, sarcomatous, and transitional areas of 6 cases of carcinosarcoma of the uterus and ovary by using epithelial and mesenchymal markers. Immunohistochemical profiles of the transitional areas were significantly different from those of carcinomatous and sarcomatous areas. Immunoreactivities for cytokeratin and epithelial membrane antigen (50% and 22.2%) were weaker than those of carcinomatous areas (95.2% and 100%), but stronger than those of sarcomatous areas (11.1% and 5.6%)(p<0.01). In transitional areas, vimentin, smooth muscle actin and S-100 protein were more strongly expressed than in carcinomatous areas, but more weakly expressed than in sarcomatous areas (p<0.01, p<0.01, and p=0.018, respectively). Myoglobin was entirely negative in carcinomatous areas and immunoreactive in minor portions of transitional and sarcomatous areas (22.2% and 16.7%, respectively). These results suggest that the transitional areas are between the carcinomatous and sarcomatous nature in differentiation, further supporting that the carcinosarcomas of the female genital tract may arise, through metaplastic change, from a type of carcinoma.

Sarcomatoid Renal Cell Carcinoma; Special Reference to its Distinction from Carcinosarcoma.: Kee Taek Jang, Yeon Mee Kim, Je Geun Chi; Korean J Pathol. 1998;32(5):378-381.

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Abstract: Sarcomatoid renal cell carcinoma is an uncommon tumor that has to be distinguished from renal carcinosarcoma. We have described three cases of sarcomatoid renal cell carcinoma showing different clinical and light microscopic features. An ultrastructural study of the tumor cells from the sarcomatoid area revealed frequent desmosomal junction, confirming the epithelial nature of the neoplasm. All three cases showed an aggressive clinical course and tended to invade adjacent organs or tissues. We believe that an histological and immunohistochemical examination in conjunction with an electron microscopic examination are necessary to diagnose sarcomatoid renal cell carcinoma.

Case Reports

Sarcomatoid Transitional Cell Carcinoma of the Renal Pelvis A report of two cases.: Kyo Young Lee, Mi seon Kwon, Yeong Jin Choi, Chang Suk Kang, Seok Jin Kang, Baying Kee Kim, Sang In Shim; Korean J Pathol. 1999;33(2):128-132.

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Abstract: Sarcomatoid carcinomas are malignant epithelial neoplasms in which the tumor cells assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. These spindle cells are malignant and manifest various amount of both vimentin and cytokeratin. Positive reaction of some of the spindle cells for cytokeratin antibodies is confirmatory. Clinical features do not differ significantly from those of patients with high-grade transitional cell carcinoma. So far, 13 cases of sarcomatoid transitional cell carcinoma of the renal pelvis have been reported in English and Korean literature. In this report, we describe clinicopathologic features of recently observed two cases of sarcomatoid transitional cell carcinoma of the renal pelvis and summarize the pathologic findings of previously reported cases with review of the literature.

Carcinosarcoma in Recurrent Lesion of Serous Cystadenocarcinoma of the Ovary: A case report.: Kyu Yun Jang, Woo Sung Moon, Dong Geun Lee; Korean J Pathol. 1999;33(3):221-224.

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Abstract PDF: Neoplasms showing both carcinomatous and sarcomatous features are well established, and have been reported in practically every organ where carcinoma can occur. But the difference in terminology and difficulties in histopathologic interpretation have hampered adequate understanding of these neoplasms. We report a case of carcinosarcoma in the recurrent form of serous cystadenocarcinoma of the ovary. The patient was a 64-year-old female who underwent total hysterectomy and bilateral salpingoophorectomy three years ago, due to perforated papillary serous cysta denocarcinoma of the right ovary. Recurrent pelvic masses contained both carcinomatous and sarcomatous components. Morphological transition between carcinomatous and sarcomatous components, and epithelial characteristics in the sarcomatous component by immunohistochemistry were recognized. We postulate the histopathogenetic mechanism based on the phenotypic conversion of carcinoma into sarcoma in the carcinosarcoma.

Primary Carcinosarcoma of the Skin.: Mee Sook Roh, Gi Yeong Huh, Sook Hee Hong; Korean J Pathol. 2001;35(5):444-446.

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Abstract PDF: Carcinosarcoma is a biphasic tumor composed of intimately admixed malignant epithelial and mesenchymal components. Primary cutaneous cases are extremely rare; there are with only 18 cases documented in English literature to date. We present a case of a 55-year-old woman with a primary carcinosarcoma of the scalp. Histologically, the lesion consisted of an undifferentiated spindle cell sarcomatous component admixed with a resembling malignant tumor with eccrine differentiation. Immunohistochemistry showed the epithelial component to express cytokeratin and EMA and lack of vimentin expression. In the sarcomatous component, the staining pattern demonstrated the reverse. The patient received adjuvant radiotherapy; but one month later a recurring nodule developed at this site, and two months later, metastasis to the neck lymph node developed. There is no evidence of recurrence or metastasis after 25 months of follow-up.

Original Article

Clonality Study in Carcinosarcomas and Malignant Mixed Epithelial Tumors.: Eun Jung Park, Yoo Duk Choi, Jong Hee Nam, Min Cheol Lee, Chang Soo Park, Sang Woo Juhng, In Seon Choi, Kyung Hee Kim, Chan Choi; Korean J Pathol. 2002;36(4):205-211.

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Abstract PDF: BACKGROUND
Tumors are usually considered to be clonal progeny of single transformed cells. Carcinosarcomas and malignant mixed epithelial tumors are examples where controversies exist regarding the singularity or multiplicity of their cell of origin.
METHODS
The authors examined the clonality of carcinosarcomas (7 cases) and malignant mixed epithelial tumor (5 cases) in female patients by X-chromosome inactivation as a marker. Each component of the tumors were picked up by the laser capture microscope. The polymorphic exon 1 CAG trinucleotide repeat in the X-linked human androgen receptor (HUMARA) gene was amplified by a polymerase chain reaction before and after treatment of the methylation-sensitive endonuclease HpaII.
RESULTS
Eleven cases were informative for clonality determination. Six out of seven carcinosarcomas and three out of four malignant mixed epithelial tumors revealed the same patterns of X-chromosome inactivation, which suggests that they are monoclonal. In contrast, the patterns of X-chromosome inactivation were different between the two tumor components in each cases of carcinosarcoma and malignant mixed epithelial tumor, indicating that they are of polyclonal origin.
CONCLUSIONS
These observations show that although most of carcinosarcomas and malignant mixed epithelial tumors are of monoclonal origin, some of them are of polyclonal origin. This finding suggests that these tumors are genuinely polyclonal, and that they originated in the neoplastic transformation of more than one somatic cells

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