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Background: Sarcomatoid carcinoma of the small bowel is an exceedingly rare gastrointestinal tumor characterized by a biphasic cellular pattern of epithelioid and mesenchymal-like cells. Due to its rarity and non-specific clinical presentation, it is frequently misdiagnosed, and there is a lack of standardized management guidelines. We report a case of multiple sarcomatoid carcinoma of the small intestine, presenting initially with gastrointestinal perforation. Additionally, we conducted a comprehensive review and analysis of the clinical manifestations, immunohistological characteristics, and prognostic factors associated with small intestinal sarcomatoid carcinoma, aiming to enhance diagnostic accuracy and therapeutic strategies for this rare malignancy. Case presentation: An 82-year-old man was admitted with a 1-week history of abdominal pain, exacerbated by the onset of fever in the last 24 hours. Abdominal CT revealed thickening of the small intestinal wall and free gas within the mesenteric space, indicating gastrointestinal perforation. Emergency surgery identified multiple tumors in the small intestine, accompanied by perforation. Postoperative pathology confirmed the diagnosis of sarcomatoid carcinoma of the small intestine. Conclusion: We report a rare case of sarcomatoid carcinoma of the small intestine and conduct a thorough literature review to offer new insights into its diagnosis, treatment, and prognosis. This highly malignant tumor, predominantly found in the jejunum and ileum, is characterized by high recurrence and metastasis rates, leading to a poor prognosis. Notably, postoperative radiotherapy does not improve outcomes. Abdominal CT is highly sensitive for detecting small bowel tumors but cannot confirm SCA due to its nonspecific imaging features. In contrast, small enteroscopy or capsule endoscopy offers greater diagnostic clarity. Increased awareness among clinicians is crucial for early detection and intervention. [ABSTRACT FROM AUTHOR]

Background: Hepatic sarcomatoid carcinoma (HSC) and hepatic sarcoma (HS) are rare malignancies. Without pathology, the differential diagnosis between these two tumors is difficult due to their frequent overlaps in clinical presentations and imaging features. Currently, there are limited analyses about the ultrasound (US), contrast-enhanced ultrasound (CEUS) and contrast-enhanced computer tomography (CECT) characteristics of HSC and HS. Therefore, the purpose of our study is to evaluate the value of US, CEUS and CECT on the differential diagnosis between HSC and HS. Methods: From 2015 to 2022, a total of 23 patients with HSC (n = 11) and HS (n = 12) are included in this retrospective study. We analyze the clinical, pathological, and imaging data of these patients. Analysis of differences is performed to determine the consistent and distinctive features. Results: HSCs have a considerably higher prevalence of chronic hepatitis (p = 0.005) and cirrhosis (p = 0.027) than HSs, while metastases are more prevalent in HSs (p = 0.005). The lesion size of HSCs (8.1 ± 2.2 cm) is slightly larger than that of HSs (6.2 ± 3.4 cm). On conventional US, the characteristics of HS and HSC are similar. In CEUS, HSCs consistently showed heterogeneous enhancement patterns, while HSs, particularly hepatic angiosarcoma (HA), demonstrated a higher prevalence of hyperintensity (75%). On CECT, all masses in both groups exhibited low density. A statistically significant difference in margin clarity was observed between HSC and HS (p = 0.015). Conclusion: HSC and HS generally present as masses with hypo-echoic and hypo-vascularity. HSC usually presents heterogeneous density. The degree of enhancement, the time of wash-out start, and the presence of necrotic areas may contribute to distinguish the different pathological types of HS. [ABSTRACT FROM AUTHOR]

Sarcomatoid carcinoma, distinguished by its histological presentation of undifferentiated, spindle-shaped cells, is a rare variant of gastric cancer when contrasted with the more typical adenocarcinoma. Gastric cancer rarely metastasizes to the small bowel; these cancers typically arise from breast, lung, or melanoma origins. Herein, we present the case of a 70-year-old male who experienced melena and significant weight loss over 3 months. An esophagogastroduodenoscopy revealed an extensive ulcerative lesion in the lower curvature of the high body of the stomach, which is consistent with the results of the computed tomography scans. Surgery involving total gastrectomy and resection of multiple segments of small-bowel tumors was conducted. Pathological examination confirmed the presence of sarcomatoid carcinoma with poorly differentiated adenocarcinoma, along with metastases to the small intestine. This report highlights the aggressiveness of gastric sarcomatoid carcinoma, as well as the potential for the small bowel to be a potential metastasis site.

The diagnosis and treatment of head and neck undifferentiated carcinoma (HNUC) present significant challenges. Herein, we present the case of a patient with advanced HNUC who underwent conversion surgery following treatment with a combination of pembrolizumab and nimotuzumab. During therapy, histological transformation from undifferentiated to sarcomatoid carcinoma was detected at the primary site. This case not only highlights the potential of immune combination-targeted therapy to reduce tumour burden and increase the surgical options for patients, but also reveals the complex alterations in tumour biology that may occur during treatment. It emphasizes the necessity for routine pathological assessments throughout the therapeutic regimen to guide personalised therapeutic strategies and optimise patient prognoses. [ABSTRACT FROM AUTHOR]

Background: Primary colorectal sarcomatoid carcinoma is a rare and aggressive malignant neoplasm that displays mixed epithelial and mesenchymal differentiation, with uncertain histogenesis. First described in 1986, there is a paucity of literature related to this condition and there are no evidence-based treatment guidelines. The aim of our study is to present our 30-year experience with primary colorectal sarcomatoid carcinoma. Methods: Retrospective single-center analysis of all patients treated for primary colorectal sarcomatoid carcinoma from 1992 to 2022. The primary outcome was response to treatment strategy and overall survival. Results: A total of six cases met eligibility criteria. Three were male (50%) with a mean age at diagnosis of 59 years (range, 49-72). Four neoplasms were located in the rectum (66%) and two in the colon. Mean tumor size at diagnosis was 4.8 cm (range, 2.8-7.0). Three patients were treated endoscopically and three underwent oncologic surgical resection. Five experienced recurrence and one expired from other comorbidities. The mean survival among those with colonic and rectal sarcomatoid carcinoma was 7 months (range, 3-11) and 39 months (range, 9-60), respectively. Discussion: Primary colorectal sarcomatoid carcinoma is a rare malignant tumor with poor prognosis. Treatment modalities have not been standardized and despite multimodal therapy, disease recurrence and/or metastasis is likely to occur. Further studies are necessary to determine optimal treatment to improve outcomes. [ABSTRACT FROM AUTHOR]

Sarcomatoid carcinoma, distinguished by its histological presentation of undifferentiated, spindle-shaped cells, is a rare variant of gastric cancer when contrasted with the more typical adenocarcinoma. Gastric cancer rarely metastasizes to the small bowel; these cancers typically arise from breast, lung, or melanoma origins. Herein, we present the case of a 70-year-old male who experienced melena and significant weight loss over 3 months. An esophagogastroduodenoscopy revealed an extensive ulcerative lesion in the lower curvature of the high body of the stomach, which is consistent with the results of the computed tomography scans. Surgery involving total gastrectomy and resection of multiple segments of small-bowel tumors was conducted. Pathological examination confirmed the presence of sarcomatoid carcinoma with poorly differentiated adenocarcinoma, along with metastases to the small intestine. This report highlights the aggressiveness of gastric sarcomatoid carcinoma, as well as the potential for the small bowel to be a potential metastasis site. [ABSTRACT FROM AUTHOR]

Background: Patients with prostate adenocarcinoma undergoing regular endocrine therapy may maintain normal PSA levels during follow-up, yet still progress to the highly malignant and rare prostatic sarcomatoid carcinoma, which is seldom reported. This article presents two case studies of prostatic sarcomatoid carcinoma. To date, only a few publications have described prostatic sarcomatoid carcinoma, and the clinical, morphological, and molecular dimensions of prostate adenocarcinoma warrant further investigation. Case description: Patient A was admitted two years ago due to difficulty urinating, with a PSA level of 6.35 ng/ml. A prostate needle biopsy was performed, and the postoperative pathology diagnosed prostate adenocarcinoma with a Gleason score of 9 (5 + 4, grade group 5). Citing personal reasons, the patient declined a radical prostatectomy and instead received ongoing androgen deprivation therapy (ADT), comprising goserelin, abiraterone, and prednisone. During follow-up, regular PSA tests showed no abnormalities. One year ago, the patient was admitted again due to difficulty urinating and hematuria, choosing to address only the urethral obstruction. Transurethral resection of the prostate was performed, and the postoperative pathology diagnosed sarcomatoid carcinoma of the prostate. Patient B was admitted three years ago due to difficulty urinating accompanied by hematuria. A prostate MRI and a whole-body radionuclide bone scan suggested prostate cancer with bone metastasis. Prostate needle biopsy confirmed the diagnosis. The patient was then regularly treated with androgen deprivation therapy, using goserelin. Throughout the follow-up period, the PSA levels consistently remained within normal limits. One year ago, the patient was admitted due to rectal bleeding. It was speculated that the symptoms of rectal bleeding might have been caused by the prostate cancer invading the rectal wall. A prostate needle biopsy was performed, and the pathology diagnosed sarcomatoid carcinoma of the prostate. Conclusions: This case underscores the inadequacy of relying solely on PSA levels to monitor high-grade prostate adenocarcinoma during endocrine therapy, as patients may progress to highly malignant atypical variants despite normal PSA levels. We propose that for high-grade prostate cancer patients who are unable to undergo radical prostatectomy, regular and frequent MRI screenings or repeat biopsies should be integral during endocrine therapy and follow-up. Furthermore, a detailed review of the patient's treatment history and clinical data, including immunohistochemical findings, might offer deeper clinical insights into prostatic sarcomatoid carcinoma. [ABSTRACT FROM AUTHOR]

Loss of histone H3K27 Trimethylation (H3K27me3) immunohistochemical expression is commonly used as an ancillary test and a surrogate marker for the diagnosis of malignant peripheral nerve sheath tumor (MPNST). A potential histological mimic of MPNST is sarcomatoid carcinoma. Prompted by an index specimen of sarcomatoid carcinoma with H3K27me3 loss and the lack of literature on such phenomenon, we sought to determine the frequency of H3K27me3 loss of expression in a cohort of sarcomatoid carcinomas. Fifty specimens of primary and metastatic sarcomatoid carcinomas with spindle cell morphology mimicking MPNST were prospectively and retrospectively retrieved from our institutional archives and stained with an antibody to H3K27me3. H3K27me3 staining was lost in 4 of the 50 specimens (8%). These specimens included a primary sarcomatoid urothelial carcinoma of the bladder resection, two local recurrences (sarcomatoid squamous cell carcinoma of the larynx and oral cavity) as well as a metastatic sarcomatoid renal cell carcinoma. Next-generation sequencing performed on all four specimens demonstrated gene mutations and copy number alterations with TP53, FANC (FANCD2 and FANCI), and TERT being the most common gene mutations and CDKN2A/B copy number loss and 11q region amplification being the most common copy number gene alterations. Mutations involving NF1, SUZ12, or EED were absent in all tested specimens. In conclusion, H3K27me3 expression may be lost in as many as 8% of sarcomatoid carcinomas which can pose as a potential diagnostic pitfall, especially in challenging sarcomatoid carcinoma specimens with absent keratin staining. [ABSTRACT FROM AUTHOR]

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BackgroundSarcomatoid carcinoma of the small bowel is an exceedingly rare gastrointestinal tumor characterized by a biphasic cellular pattern of epithelioid and mesenchymal-like cells. Due to its rarity and non-specific clinical presentation, it is frequently misdiagnosed, and there is a lack of standardized management guidelines. We report a case of multiple sarcomatoid carcinoma of the small intestine, presenting initially with gastrointestinal perforation. Additionally, we conducted a comprehensive review and analysis of the clinical manifestations, immunohistological characteristics, and prognostic factors associated with small intestinal sarcomatoid carcinoma, aiming to enhance diagnostic accuracy and therapeutic strategies for this rare malignancy.Case presentationAn 82-year-old man was admitted with a 1-week history of abdominal pain, exacerbated by the onset of fever in the last 24 hours. Abdominal CT revealed thickening of the small intestinal wall and free gas within the mesenteric space, indicating gastrointestinal perforation. Emergency surgery identified multiple tumors in the small intestine, accompanied by perforation. Postoperative pathology confirmed the diagnosis of sarcomatoid carcinoma of the small intestine.ConclusionWe report a rare case of sarcomatoid carcinoma of the small intestine and conduct a thorough literature review to offer new insights into its diagnosis, treatment, and prognosis. This highly malignant tumor, predominantly found in the jejunum and ileum, is characterized by high recurrence and metastasis rates, leading to a poor prognosis. Notably, postoperative radiotherapy does not improve outcomes. Abdominal CT is highly sensitive for detecting small bowel tumors but cannot confirm SCA due to its nonspecific imaging features. In contrast, small enteroscopy or capsule endoscopy offers greater diagnostic clarity. Increased awareness among clinicians is crucial for early detection and intervention.

Pulmonary spindle cell carcinoma (PSCC) is a rare and highly aggressive form of nonsmall cell lung cancer with sarcomatoid differentiation. It poses significant diagnostic challenges due to its histological resemblance to other malignancies, including inflammatory myofibroblastic tumors. This case report details the clinical presentation, histopathological findings, and treatment of a patient with PSCC, to further elucidate the clinical features, diagnosis, and management of this rare tumor.

The diagnosis and treatment of head and neck undifferentiated carcinoma (HNUC) present significant challenges. Herein, we present the case of a patient with advanced HNUC who underwent conversion surgery following treatment with a combination of pembrolizumab and nimotuzumab. During therapy, histological transformation from undifferentiated to sarcomatoid carcinoma was detected at the primary site. This case not only highlights the potential of immune combination-targeted therapy to reduce tumour burden and increase the surgical options for patients, but also reveals the complex alterations in tumour biology that may occur during treatment. It emphasizes the necessity for routine pathological assessments throughout the therapeutic regimen to guide personalised therapeutic strategies and optimise patient prognoses.

Sarcomatoid carcinoma (SC) is a rare, complex, aggressive tumor that spreads rapidly, is highly malignant, and has metastasized. Surgical resection is the primary treatment, and it usually occurs in the lungs and kidneys but rarely in the neck. Patients with advanced sarcomatoid carcinoma (SC) of the head and neck (HN) have a poor progonsis. In recent years, immune checkpoint inhibitors (ICIs) have been established as treatments for many solid tumors; however, the effectiveness of ICIs in treating SC of HN is still little recognized. We report a case study of a middle-aged woman with primary sarcomatoid carcinoma of the neck. She developed sarcomatoid carcinoma of the contralateral neck 7 months after the first surgical treatment. Subsequently, disease recurrence and metastasis occurred 8 months after the second surgery. The patient did not receive any treatment after both surgeries. The tumor showed high programmed death-ligand 1 (PD-L1) expression, with a combined positive score (CPS): 95. The patient's response to treatment was assessed as partial remission (PR) after 2 cycles of anlotinib combined with sintilimab. The patient has survived for over 2 years and remains in PR status, despite experiencing grade 2 hypothyroidism as an adverse event during treatment. The case highlights the efficacy and safety of anlotinib and sintilimab as a first-line treatment. [ABSTRACT FROM AUTHOR]

Pulmonary spindle cell carcinoma (PSCC) is a rare and highly aggressive form of nonsmall cell lung cancer with sarcomatoid differentiation. It poses significant diagnostic challenges due to its histological resemblance to other malignancies, including inflammatory myofibroblastic tumors. This case report details the clinical presentation, histopathological findings, and treatment of a patient with PSCC, to further elucidate the clinical features, diagnosis, and management of this rare tumor. [ABSTRACT FROM AUTHOR]

The diagnosis of head and neck spindle cell squamous carcinoma (SC-SCC) is often challenging. Lesions with a prominent inflammatory infiltrate and reactive vessels may have a granulation tissue-like appearance, therefore being difficult to distinguish from reactive lesions, like contact ulcers, post-intubation granulomas, inflammatory pseudotumors, or benign vascular lesions. In this study, we analyzed the clinicopathological features of a series of 17 head and neck SC-SCC with granulation tissue-like appearance. All patients, but two, were males, ranging in age between 57 and 80 years. The larynx was the most frequently affected site (n = 12), followed by the tongue (n = 4). One tumor was hypopharyngeal. Most consult cases were submitted with benign suggestion or because of unexpected recurrences of granulation tissue polyps. Histologically, all lesions consisted of an ulcerated polypoid proliferation of moderately to markedly atypical spindle cells, with a minor component of conventional invasive or in situ squamous carcinoma. At least one cytokeratin cocktail was positive in 13 cases. The staining was limited to a few neoplastic cells in most cases. Positivity for p63, p40, and cytokeratins 5/6 was detected only in the conventional squamous cell carcinoma component, when present. ALK1 was negative in all cases. Sixteen cases were tested for p53 and all showed aberrant expression (12 diffusely positive and 4 of null-phenotype). The diagnosis of granulation tissue-like SC-SCC is challenging due to the close clinical and histological overlap with several benign conditions. Since the expression of epithelial markers is limited, the use of an immunohistochemical panel including p53 is recommended. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Sarcomatoid carcinoma, a rare and aggressive subtype of bladder cancer, accounting for 0.3% of cases, is more aggressive than urothelial carcinomas. Accurate diagnosis, crucial for treatment, can be challenging. We present a characterized case of sarcomatoid carcinoma of the urinary bladder using multimodal imaging and pathology. [ABSTRACT FROM AUTHOR]

Pulmonary blastomas (PB) are rare, aggressive tumours which constitute

Histological transformation is a phenomenon that is well described as one of the causes of tyrosine kinase inhibitor resistance in oncogene-driven non-small-cell lung cancer (NSCLC). The use of immune checkpoint inhibitors (ICIs) as a potential mechanism of acquired resistance to immunotherapy in NSCLC to small-cell lung cancer was also recently found. Here, we report the histological transformation of sarcomatoid carcinoma and metastasis in a lung adenocarcinoma patient without targetable genetic alterations who experienced long-term disease remission after nivolumab therapy. The patient subsequently developed rapid progression in the mediastinal and retroperitoneal lymph nodes, bones, and small intestine. Surgical resection of the small intestine lesion due to acute small intestine bleeding revealed the transformation of NSCLC to sarcomatoid carcinoma. The patient died 3 months after sarcomatoid carcinoma transformation and extensive disease progression, although he was rechallenged with immunotherapy. Genomic and immunohistochemical analyses revealed a comparable abundance of gene mutations and a limited number of immune cells in the tumor microenvironment, with low infiltration of CD8+ T cells, CD4+ T cells, regulatory T cells, and PD-L1+ macrophages in metastatic tumors, revealing a noninflamed immune microenvironment for ICI-resistant tumors. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to develop nomograms based on the SEER database to predict the prognosis for patients with primary sarcomatoid carcinoma of the urinary bladder (SCUB). Materials and Methods: Patients with primary SCUB were identified in the Surveillance, Epidemiology, and End Results (SEER) database, between 1975 and 2017. Univariate and multivariable Cox analysis were conducted to identify the independent prognostic factors for developing the overall survival (OS) and cancer-specific survival (CSS) nomograms. Then, concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the accuracy of the nomogram model. In addition, the model was further compared with TNM staging system. Results: A total of 238 eligible patients with primary SCUB were selected from the SEER database. As suggested by Cox-analysis, age, sex, T stage, M stage, tumor size, and surgery type of primary site were identified as the independent factors for predicting both OS and CSS. We developed OS and CSS nomograms with a favorable C-index by using these prognostic factors. The C-indexes of the OS and CSS nomogram in the present study were 0.738 (0.701-0.775) and 0.763 (0.724-0.802), which were superior to those of the AJCC TNM staging with 0.621 (0.576-0.666) and 0.637 (0.588-0.686) respectively, showing better discriminatory ability. Subsequently, the ROC curves showed that the 1-, 3- and 5-year AUCs (area under the curve) of OS nomogram (i.e., 0.793, 0.807 and 0.793) were higher than those of the TNM stage((i.e., 0.659, 0.676, 0.659). Similarly, as for CSS model, them ((i.e., 0.823, 0.804 and 0.804) were aslo exceed those of TNM stage((i.e., 0.683, 0.682, 0.682). Furthermore, the calibration curves indicated a good consistency between the predictive survival and the actual survival. Finally, patients were stratified by risk, and Kaplan-Meier survival curve suggested that the prognosis of the low-risk group was significantly better than that of the high-risk group. Conclusion: We developed nomograms with the SEER database, which could help predict the prognosis of SCUB individuals more accurately. [ABSTRACT FROM AUTHOR]

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Lung sarcomatoid carcinoma is a rare tumor. We report a rare case of pancreatic metastasis in a 76-year-old man with lung sarcomatoid carcinoma. Right upper lobectomy was performed, and the patient was diagnosed with pulmonary sarcomatoid carcinoma with a MET exon 14 skipping mutation. A biopsy of the pancreatic lesion subsequently revealed pancreatic metastasis. A MET exon 14 skipping mutation was confirmed, and the patient was treated with a MET tyrosine kinase inhibitor and maintained a complete response for 2 years. Lung sarcomatoid carcinoma rarely metastasizes to the pancreas and can be adequately treated with a MET tyrosine kinase inhibitor.

Sarcomatoid carcinoma (SC), which can occur in any organ, is a rare disease. To elucidate common characteristics of SC beyond organs, we evaluated clinicopathological and immunological features of SC defined by the single histological criterion beyond organs compared to randomly matched conventional carcinoma (non‐SC) adjusted for the disease stage. Immunological features were assessed by multiplex immunohistochemistry, comparing immune cell density in tumor tissues and tumor programmed death‐ligand 1 (PD‐L1) expression. A total of 101 patients with SC or non‐SC (31 lung, 19 esophagus, 22 pancreas, 15 liver, 4 bile duct, 6 kidney, 2 uterus and 2 ovary) were identified among 7197 patients who underwent surgery at our institute (1997‐2020). SC was significantly associated with worse survival (HR: 1.571; 95% CI: 1.084‐2.277; P =.017). The frequency of postoperative progression within 6 months was significantly higher for SC patients (54% vs 28%; P =.002). The immune profiling revealed the densities of CD8+ T cells (130 vs 72 cells/mm2; P =.004) and tumor‐associated macrophages (566 vs 413 cells/mm2; P <.0001) and the tumor PD‐L1 expression score (40% vs 5%; P <.0001) were significantly higher in SCs than in non‐SCs. Among 73 SC patients with postoperative progression, multivariate Cox regression analysis showed that immunotherapy tended to be associated with favorable survival (HR: 0.256; 95% CI: 0.062‐1.057; P =.060). Collectively, SCs shared clinicopathological and immunological features across organs. Our study can initiate to standardize the pathological definition of SC and provide a rationale for the investigation and development for this rare disease in a cross‐organ manner. [ABSTRACT FROM AUTHOR]

Sarcomatoid carcinoma is a rare tumour consisting of both sarcomatous and carcinomatous elements. It accounts for less than 1% of laryngeal malignancies. This case report describes sarcomatoid carcinoma of the larynx in a 54-year-old male managed by total laryngectomy with post operative radiotherapy. Surgery is the treatment modality of choice for this rare entity. However, early stage sarcomatoid carcinoma tumours are better treated with radiotherapy alone similar to early stage squamous cell carcinoma of the larynx with favourable results. [ABSTRACT FROM AUTHOR]

Carcinosarcomas of mediastinum are rare and only few well-documented cases are available in the literature. We report a detailed description of mediastinal carcinosarcoma with unique clinical manifestations and immunohistochemical and molecular profiles. A 44-year-old female with an enlarging anterior mediastinal mass was found to have a positive pregnancy test. Thoracoscopic biopsy revealed that the mass represented a carcinosarcoma with adenocarcinoma and chondrosarcoma components. The tumor focally expressed beta-HCG by immunohistochemistry and had KRAS G12A missense mutation by next generation sequencing. The case documents a rare presentation of carcinosarcoma within the mediastinum with uncommon paraneoplastic syndrome and genetic profile. Awareness of these unusual clinical and pathological manifestations of the tumor will help in reaching correct diagnosis and proper management of such patients. [ABSTRACT FROM AUTHOR]

Introduction. Carcinoma with sarcomatoid components is a highly malignant tumor exhibiting both epithelial and stromal malignant differentiation. Its tumorigenesis is associated with epithelial–mesenchymal transition (EMT), and phenotypic changes from carcinoma to sarcoma are associated with TP53 mutations. Case presentation. A 73-year-old female with bloody stool was diagnosed with rectal adenocarcinoma. She underwent trans-anal mucosal resection. Histopathologically, the tumor cells showed 2 morphologically distinct populations. One was composed of well-formed to fused glands or cribriform glands and was considered a moderately differentiated adenocarcinoma. The other consisted of pleomorphic discohesive atypical tumor cells with spindle and/or giant cell features, which was considered a sarcomatous tumor. Immunohistochemistry analysis showed that E-cadherin expression changed from positive to negative in the sarcomatous component. On the other hand, ZEB1 and SLUG were positive. Finally, she was diagnosed with carcinoma with a sarcomatoid component. We performed a mutation analysis by next genome sequencing and found KRAS and TP53 mutations in both carcinomatous and sarcomatous components. Conclusions. Immunohistochemistry and mutation analyses revealed tumorigenesis of rectal carcinoma with sarcomatoid components correlated with EMT and TP53 mutations. [ABSTRACT FROM AUTHOR]

Basal cell carcinosarcoma (BCCS) is a rare malignant biphasic tumor of the skin, composed of epithelial and mesenchymal components, and may be underdiagnosed. We sought to summarize the current understanding of BCCS including its reported history, clinical presentation, diagnosis, and treatment. We also reappraise and present our recommendations of histological interpretation for its diagnosis and treatment. A systematic review of PubMed and EMBASE, from inception of databases to December 1, 2022, identified all reported cases of basal cell carcinosarcoma. A total of 34 reports containing 54 patients with basal cell carcinosarcoma were included. The neoplasm was most commonly associated in areas of sun-exposed skin and primarily affected the elderly. Diagnosis was made on histology specimens using H&E. To address underdiagnosis, additional immunohistochemical markers have been proposed due to unreliable phenotypic appearance in this poorly differentiated neoplasm. Treatment consists of excision of the tumor, typically with Mohs surgery, and is curative in most cases. There are limited treatment options for metastatic disease. There were limitations to this study as various immunohistochemical stains used on suspected BCCS without providing an explanation as to why certain markers were included and others were excluded. Continued efforts in characterizing this complex neoplasm are critical in establishing reliable and accurate diagnostic tests and accompanying treatment options, especially in cases of metastatic disease. [ABSTRACT FROM AUTHOR]

Detailed genetic and immunohistochemical features of a sarcomatoid carcinoma of the gallbladder were reported. Studied was a resected gallbladder tumor involving the transverse colon, which was consisted of 3 histopathological neoplastic components, i.e., high-grade dysplasia, adenocarcinoma, and sarcomatoid carcinoma. The targeted amplicon sequencing showed somatic mutations in TP53 (p.S90fs) and ARID1A (c.4993 + 1G > T) in all of the 3 components. Copy numbers of CDKN2A and SMAD4 were decreased in the adenocarcinoma and the sarcomatoid component. Immunohistochemistry showed loss of expression of p53 and ARID1A in all components. p16 expression was lost in the adenocarcinoma and the sarcomatoid component, while SMAD4 expression was lost only in the latter. These results suggest that this sarcomatoid carcinoma may have developed by progression from high-grade dysplasia via adenocarcinoma with sequential accumulation of molecular aberrations involving p53, ARID1A, p16, and SMAD4. This information should serve to understand the molecular mechanism of this very intractable tumor. [ABSTRACT FROM AUTHOR]

Sarcomatoid carcinoma of head and neck is a rare type of squamous cell carcinoma (SCC) with sarcomatoid features associated with a poor prognosis. This study aimed to summarize the clinical characteristics, prognosis and treatment options for these patients. Patients diagnosed with a sarcomatoid carcinoma of the head and neck between December 2012 to November 2022 were selected from the pathology database of Gustave Roussy. The data (patients, tumor characteristics, treatment, outcomes, etc.) were collected retrospectively. Multivariable prognosis analysis of progression free survival (PFS), and overall survival (OS) were performed. A total of 57 cases of sarcomatoid carcinoma were included. There were 41 (72%) males and 16 (28%) females. The median age at diagnosis was 64 years. The oral cavity (32%) and the larynx (26%) were the most common tumor sites, followed by the oropharynx (23%), posterior wall of the pharynx and maxillary sinus (5%). 17 patients (30%) were no smokers. More than half of the patients (65%) presented with advanced-stage disease (T3, T4), 95% of them had no metastatic disease at diagnosis. A total of 37 patients (65%) had no previous history of head and neck cancers (de novo tumors), and 25 (44%) arised in irradiated areas. Among all, 28 (49%) underwent a surgical treatment, for 9 (32%) the resection was R1, 9 patients had perineural invasion, and 6 of them presented vascular embols. 32% had nodal metastasis. The other 51 % of patients received radiochemotherapy (n=15), palliative chemotherapy (n=10), or best supportive care (n=4). The follow-up was 51.8 months. The median [95%CI] OS and PFS were 29.7 months [13.8;49.2] and 9.5 months [7.5;22.8]. The multivariable prognostic analysis showed that age, T stage, site (larynx and oral cavity), no history of head and neck cancer, and the presence of a tumor in irradiated site were significantly correlated with a poor OS. With the exception ofno history of head and neck cancer, all of the above negatively influenced the PFS Sarcomatoid carcinoma is a different entity from the conventional SCC of head and neck. This type of tumor is very aggressive and has a poor prognosis. Tumors in irradiated site have a significant poor prognostic. Further clinical trials are needed to establish the best treatment strategy for these tumors. [ABSTRACT FROM AUTHOR]

Background: Sarcomatoid carcinoma (SCA) of the jejunum is an extremely rare malignancy of the small intestine, with only about 20 cases reported to date. This type of cancer has features of both epithelial and mesenchymal tumors. Case Presentation: This case report describes a male patient in his 70s who presented with recurrent episodes of passage of melena. Conclusion: The diagnosis of SCA was confirmed by immunohistochemistry and this case emphasizes the course and metastatic nature of the tumor including constraints surrounding management. [ABSTRACT FROM AUTHOR]

Sarcomatoid carcinoma is rarely diagnosed as gallbladder cancer. Its aggressive nature, due to the characteristics of both sarcoma and carcinoma, results in a poor prognosis. We report a case of gallbladder sarcomatoid carcinoma in an 82-year-old male who was referred to our hospital for evaluation of gallbladder cancer observed on abdominopelvic computed tomography. The characteristics of the cancer were not confirmed after several imaging modalities. The surgically resected tumor was positive for both cytokeratin and vimentin as revealed via immunohistochemical staining, and a sarcomatoid carcinoma was finally diagnosed. The role of chemotherapy has not yet been identified. Therefore, radiation therapy is planned to reduce the risk of recurrence. [ABSTRACT FROM AUTHOR]

Carcinosarcomas are rare malignant tumors derived of both epithelial and mesenchymal elements. Herein, we report an elderly man originally diagnosed with a squamous cell carcinoma of the hand. Upon excision, the tumor was found to be a more aggressive carcinosarcoma. Immunohistochemical stains revealed that the sarcoma component of the lesion was vimentin positive, whereas the primary carcinoma tumor cells were positive for p63 and CK903. Both components were negative for CD34 and D2-40. This tumor was found to have angiolymphatic invasion and eventually metastasized to the axillary lymph nodes and lungs.

Objective: The present study was aimed to comprehensively characterize the epidemiological, clinicopathological characteristics, treatments, and prognosis of intraoral spindle cell carcinoma (SpCC). Materials and Methods: Patients diagnosed with intraoral SpCC at our institution in the past 15 years (2005–2019) were screened from inpatient disease registry. All relevant data concerning patients with intraoral SpCC were retrieved. Previous reports about intraoral SpCC with adequate clinicopathological data in both English literature and Chinese literature were collected. Eligible cases were further reviewed and pooled for statistical analyses. Results: Six patients (5 females and 1 male; average age: 59 years) with intraoral SpCC were histopathologically diagnosed and surgically treated at our institution. The literature review identified another 63 published cases from 34 articles. Most cases were presented in the fifth to seventh decade of life with a male preponderance. Gingiva (23/69, 33.3%) was the most common site followed by the tongue (19/69, 27.5%) and buccal mucosa (8/69, 11.6%). Complete surgical ablation remains the primary treatment option. Tumor size, pathological grades, cervical node metastasis, and distant metastasis were significantly associated with reduced survival. Conclusions: Intraoral SpCC is an uncommon and aggressive malignancy with dismal prognosis. Much attention and effort are needed to characterize this rare entity and improve its clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Sarcomatoid hepatocellular carcinoma (SHC) is a rare epithelial malignancy with high invasiveness and poor prognosis. However, the molecular characteristics and main driver genes for SHC have not been determined. The aim of this study is to explore the potentially actionable mutations of driver genes, which may provide more therapeutic options for SHC. Methods: In this study, DNA extraction and library preparation were performed using tumor tissues from 28 SHC patients. Then we used Miseq platform (Illumina) to sequence the target-enriched library, and we aligned and processed the sequencing data. The gene groups were tested for SNVs/ Indels/CNVs. Tumor mutation burden (TMB) was assessed by the 425- cancer-relevant gene panel. Multivariate analysis of COX’s model was used for survival analysis (OS) of patients’ clinical characteristics. Result: The median overall survival (OS) of the patients was only 4.4 months. TP53, TERT, and KRAS were the top three frequently mutated genes, with frequencies of 89.3%, 64.3%, and 21.4%, respectively. A considerable number of patients carried mutations in genes involved in the TP53 pathway (96%) and DNA Damage Repair (DDR) pathway (21%). Multiple potentially actionable mutations, such as NTRK1 fusions and BRCA1/2 mutations, were identified in SHCs. Conclusions: This study shows a landscape of gene mutations in SHC. SHC has high mutation rates in TP53 pathway and DDR pathway. The potentially actionable mutations of driver genes may provide more therapeutic options for SHC. Survival analysis found that age, smoking, drinking, and tumor diameter may be independent prognostic predictors of SHC. [ABSTRACT FROM AUTHOR]

Sarcomatoid carcinoma is a rare type of gallbladder cancer with less than 100 cases reported in the literature. Preoperative diagnosis is difficult due to nonspecific clinical and radiological findings. Its prognosis is poor due to rapid progression and a high short‐term recurrence rate. The definitive diagnosis relies on histopathological examination. [ABSTRACT FROM AUTHOR]

Sarcomatoid urothelial carcinoma (SUC) is a rare histologic subtype with poor prognosis. While there is known intra-tumoral heterogeneity between individual SUC tumors, the relationship between sarcomatoid and conventional urothelial carcinoma (CUC) within the same patient is poorly understood. The objective of this study was to identify differences between the sarcomatoid and CUC tumor microenvironment components that may drive this aggressive phenotype. Using tissue microarrays from eight patient tumors with mixed CUC and SUC, we examined paired CUC, mixed urothelial carcinoma (UC) regions, and SUC using the Nanostring Digital Spatial Profiling platform. We found SUC and mixed UC had higher levels of stromal cells, predominately macrophages and fibroblasts, when compared with CUC within the same tumor. CD14, CD163, and transforming growth factor-beta levels were significantly higher in SUC than in CUC. Immunohistochemical analysis revealed consistently moderate to strong expression of CD163-positive antigen-presenting cells (APCs) in SUC regions, whereas CD68-positive APC expression was generally absent. Thus, in mixed histology SUC, the SUC component preferentially expressed CD163-positive APCs and fibroblasts compared to the CUC component. As CD163-positive APCs and fibroblasts are known to be tumor-promoting and immune-suppressive, this infiltration may contribute to epithelial to mesenchymal transition and other aggressive properties of SUC., (© 2025 The Author(s). The Journal of Pathology: Clinical Research published by The Pathological Society of Great Britain and Ireland and John Wiley & Sons Ltd.)

Aims: Primary cutaneous sarcomatoid squamous cell carcinoma (PCSSCC) is an uncommon variant of squamous cell carcinoma. Histologically, these tumours are composed of deeply infiltrative spindled and pleomorphic cells arranged in fascicles or cohesive nests and usually lacking keratinisation. Its distinction from other malignant spindle cell lesions is a difficult task that requires ancillary immunohistochemical studies to make a definitive diagnosis. A retrospective analysis of 74 cases of PCSSCC, obtained from large academic institutions, was performed, and is summarised below., Methods and Results: Immunohistochemical studies were performed with antibodies against pan-cytokeratin monoclonal antibody (AE1/AE3), anti-cytokeratin (CAM 5.2) mouse monoclonal primary antibody, MNF-116, p63, p40, high-molecular-weight kininogen (HMWK), cytokeratin (CK)7, CK5/6, smooth muscle actin (SMA), desmin and H-caldesmon. All cases were poorly differentiated; however, there were some histopathological clues to the diagnosis of PCSSCC; namely, the presence of a well-differentiated component in 13 cases. Using immunohistochemistry, all cases were positive for at least one epithelial marker (AE1/AE3, MNF116, CAM5.2, p63, p40, HMWK and CK5/6). Eighteen cases had aberrant expression of SMA., Conclusions: PCSSCC can be a difficult neoplasm to diagnose, as it can appear histologically similar to other malignant spindle cell neoplasms. We describe 74 cases of PCSSCC, highlighting their salient clinical, histopathological and immunohistochemical features, and discuss the potential diagnostic pitfalls in distinguishing this entity from other malignant neoplasms. Our results indicate that a combination of thorough histological inspection coupled with an adequate battery of immunohistochemical stains is necessary to support the diagnosis of PCSSCC., (© 2025 John Wiley & Sons Ltd.)

Sarcomatoid cancer of unknown primary site is an aggressive and rare clinical entity associated with poor patient outcomes. We describe a case of a 69-year-old woman who presented with low back pain, right leg weakness, urinary retention, and weight loss. Spinal imaging revealed a soft tissue mass at the right sacral ala infiltrating the S2-S4 neural foramina, with multifocal marrow replacement of the lumbosacral spine and adjacent bilateral iliac bones. Metastatic workup revealed additional lesions of the cervicothoracic spine, left proximal tibia and distal femur, and bilateral pulmonary nodules. Needle biopsy of the sacral mass was consistent with spindle cell carcinoma, a subtype of sarcomatoid carcinoma. IHC staining was positive for GATA3, suggesting mammary or urothelial origin. However, random bladder biopsies obtained at cystoscopy were negative for malignancy and no other discernable primary tumor was identified on full body imaging. This case highlights a rare histologic type of cancer - sarcomatoid carcinoma of unknown primary site (SCUP) in a patient that presented with cauda equina syndrome. Our patient was offered palliative radiation for symptom relief but elected to pursue hospice after the first radiation session. She passed away at a hospice facility within a few months after discharge from the hospital., Competing Interests: The authors declare they have no conflicts of interest

Abstract Background Sarcomatoid carcinoma (also called carcinosarcoma in the latest WHO classification 2016) of the prostate gland is a biphasic malignant neoplasm which exhibits epithelial and mesenchymal differentiation [1]. Sarcomatoid carcinoma is a rare tumour, considered as a variant of acinar adenocarcinoma in the WHO classification, with less than 200 reported cases in the literature to date [2]. Sarcomatoid carcinoma of prostate presenting with bilateral cervical lymph node deposits as the first clinical manifestation, is even rarer, and reported cases were not found in the literature; hence, this is the first case report of such, to the best of our knowledge. Case presentation We report a case of sarcomatoid carcinoma of the prostate in a 72-year-old Sri Lankan man who presented with bilateral cervical lymphadenopathy. He had hard nodular prostate on digital rectal examination (DRE). Ultrasound scan of abdomen (USS) revealed the presence of paraaortic lymphadenopathy, in addition. The excision biopsy of the right cervical lymph node revealed deposit of a carcinoma of epithelioid histomorphology, which showed patchy strong positivity for immunohistochemical marker (IHCm), PSA. His serum PSA value was 48 ng/ml (reference

Sarcomatoid carcinoma is a very rare morphologic entity of the female genital tract and even more rare in the cervix. Sarcomatoid carcinoma is a rare form of cancer in which the cells exhibit properties characteristic of both epithelial and mesenchymal tumors and looks like a mixture of carcinoma and sarcoma. It differs from squamous cell carcinomas of the cervix in terms of having a poorer prognosis and a short disease-free survival. The tumor is usually diagnosed at an advanced stage of presentation and is characterized by early recurrence following treatment. Surgery or radiotherapy remains the mainstay of treatment. A rare case of sarcomatoid carcinoma of the cervix in a 42-year-old female patient is reported here. The patient was examined, and biopsy from the polypoidal mass of the cervix was performed. Immunohistochemistry examination was done which favored the diagnosis as sarcomatoid carcinoma of the cervix with positivity for vimentin and P63 markers and diffuse staining of actin and negativity for CK7, CEA, ER, desmin, HMB45, MYOD1, EMA, CD10, and CK5/6. The patient was clinically defined as having International Federation of Gynecology and Obstetrics stage IIIB disease. The patient was treated by radiotherapy with a palliative approach according to clinical disease. The pathologic diagnosis of sarcomatoid carcinoma is based on histologic and immunohistochemical findings. As this entity of cervical cancer is very rare, it is difficult to draw a firm decision on disease behavior, diagnostic methods, best treatment option, and outcome. Reporting such cases might help oncologists to understand this entity of cervical cancer.

Background: Pulmonary sarcomatoid carcinoma (PSC) constitutes a heterogeneous group of poorly differentiated non-small cell lung cancers. Since these are rare tumours, we sought to determine the characteristics and clinical outcomes of these patients treated at our centre. Methods: We did a retrospective evaluation of all patients diagnosed with PSC between January 2013 and September 2020 at the Tata Memorial Hospital, Mumbai, India. Baseline demographic and treatment data and outcomes were obtained retrospectively from electronic medical records and survival was calculated by using the Kaplan--Meier method. Results: Out of 151 patients diagnosed with PSC during this period, 129 were included in the final analysis. The clinical stage was stage I in 3 (2.03%), stage II in 4 (3.1%), stage III in 35 (27.1%) and stage IV in 87 (67.4%). The median follow-up duration was 32 months (range, 15.0-48.9). The median overall survival (OS) of patients who received curative surgery was 18 months (95% confidence interval (95% CI), 2.59-33.4); concurrent chemoradiation was 11 months (95% CI, 2.99-19); palliative chemotherapy was 8 months (95% CI, 5.24-10.75) and best supportive care was 1 month (95% CI, 0.43-1.57, p = 0.001). On multivariate analysis, the presence of brain metastasis (p = 0.018; hazard ratio (HR), 2.47; 95% CI, 1.34-4.49) and the administration of chemotherapy (p = 0.037; HR, 2.2; 95% CI, 1.04-4.94) were the only factors impacting the OS. Conclusion: PSC usually presents in advanced stages and is associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Sarcomatoid carcinoma (SC) is rare in the sinonasal cavity with poor prognosis. This study aimed to summarize the clinical characteristics, treatment and prognosis of patients with sinonasal SC from a single tertiary medical center.Methods: Retrospective review of the clinical data of seven patients diagnosed with sinonasal SC from May 1988 to February 2021.Results: Seven patients with SC in nasal cavity and paranasal sinus, including six males and one female, aged 34-77 years (mean, 58.3 years), were included in this case series. The common presenting symptoms included epistaxis and nasal obstruction. The tumor usually occurred in nasal cavity, maxillary sinus and ethmoid sinus. Most patients were diagnosed at advanced stages with the involvement of orbit and skull base. Open and endoscopic surgery were performed in five and two patients, respectively. The follow-up period ranged from 3 to 26 months. Four patients died of disease within one year, though two received adjuvant chemotherapy and one received radiotherapy. Two patients survived without recurrence at the end of follow-up, both of them underwent adjuvant radiotherapy. One patient received palliative re-irradiation due to local recurrence of the tumor three months after the surgery, however, this patient was lost to follow-up.Conclusions: Sinonasal SC is a rare entity with an aggressive behavior and poor prognosis. Early diagnosis and multimodality treatment are recommended to improve the survival. [ABSTRACT FROM AUTHOR]