Multiple adenocarcinomas and synchronous leiomyosarcoma of the colon: a case report
M.C. De Nisi, C.Maggiore, C.Minacci, M.Stumpo,M.L. Palmeri, L. Pergola, A. Genovese, A. Rossi.U.O.C. Anatomia Patologica-Grosseto
Congresso Nazionale SIAPEC-IAP
7-9 settembre 2009-Firenze
CLINICAL PRESENTATION
73 YEAR OLD MAN WITH OBSTRUCTIVE NEOPLASM
NO CANCER PREDISPOSITION SYNDROME
NO PREGRESS NEOPLASM REFERRED
GROSS EXAMINATION
8 POLYPOID TUMOURS RANGINGFROM 0,3 TO 5 CM: THE LARGEST NEOPLASM WAS
COMPOSED OF A POLYPOID COMPONENT AND A HARD INFILTRATING ONE;
THE REMAINING LESIONS WERE POLYPOID ONLY
MICROSCOPIC EXAMINATION
SIX SMALLER POLYPS WERE TUBULO-VILLOUS ADENOMAS
THE SECOND LARGEST NEOPLASM WAS AN ADENOCARCINOMA
G2 - pT3 N0 Mx THE LARGEST LESION WAS COMPOSED
OF TWO DIFFERENT TUMOURS: A TYPICAL ADENOCARCINOMA AND A LOW GRADE LEIOMYOSARCOMA
DIFFERENTIAL DIAGNOSIS
???? COLLISION TUMOURS
OR
ADENOCARCINOMA WITH SARCOMATOID
DIFFERENTIATION ???
LITERATURE➢ A case of rectosigmoid carcinoma with concurrent, but
distinct, rectal leiomyosarcoma(Alfonso A.E. Et all: Synchronous leiomyosarcoma and adenocarcinoma of the rectum: report of a case and rewiew of the literature. Dis. Colon Rectum, 18: 228-231, 1975)
➢ A case of leiomyosarcoma developing in the colostomy of a patient treated for rectal adenocarcinoma (Witz M et all.: Methachronous leiomyosarcoma in colostomy after abdominoperitoneal resection for rectal carcinoma.J. Surg. Oncol.,32:200-202, 1986)
LITERATURE Only one carcinosarcoma with adenosquamous, osseus,
cartilaginous and non specific spindle cell differentiation (Weidner N.: Carcinosarcoma of the colon. Report of a unique case with light and immunohistochemical studies. Cancer, 58: 1126-1130, 1986)
Only one case of neoplasm exibiting two distinct components, one epithelial and one sarcomatous whose cells reacted with a monoclonal antibody agaist actin (Di palma S. et all: Association of adenocarcinoma and leiomyosarcoma of the sigmoid colon. A case report. Tumori, 77: 175-177, 1991)
DEFINITION
➢ COLLISION TUMOR: a tumour with a distinct boundary between two different components (i.e. adenocarcinoma and sarcoma) (WHO 2000)
➢ CARCINOSARCOMA: malignant tumours containing both carcinomatous and heterologous mesenchymal elements (WHO 2000)
MORPHOLOGY
THE NEOPLASM WAS COMPOSED OF A DISCRETE SARCOMATOUS AND GLANDULAR COMPONENT WITH NO MORFOLOGICAL “TRANSITION” BETWEEN THE TWO DIFFERENT NEOPLASTIC TISSUES
MORPHOLOGY
4x 40x
IMMUNOPHENOTYPE THE ADENOCARCINOMATOUS
CELLS WERE: AE1AE3+;CEAP+;Vimentin; Actin-; Desmin-.
THE SARCOMATOUS CELLS STAINED DIFFUSELY AND STRONGLY WITH Vimentin, Desmin and Actin; NEGATIVE FOR Cytokeratins, CEA-P and CD117.
IMMUNOPHENOTYPE
AE1AE3
CEA-P
Vimentin
CONCLUSION
MORPHOLOGICAL ANDIMMUNOISTOCHEMICALRESULTS RULED OUTTHE DIAGNOSISOF CARCINOSARCOMA OR METAPLASTIC ADENOCARCINOMA WHILE SUPPORTED THE HYPOTHESIS OF TWODIFFERENT NEOPLASTIC CLONES
DIAGNOSIS
LOW GRADE LEOMYOSARCOMA
SYNCHRONOUS WITH
TWO INFILTRATING
ADENOCARCINOMAS
AND MULTIPLE ADENOMAS
THANKS FOR YOUR ATTENTION