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Carcinosarcoma of the stomach: four cases that expand the morphologic spectrum of gastric cancer with a primitive phenotype

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Abstract

Carcinosarcoma of the stomach is a rare neoplasm characterized by the presence of both epithelial and mesenchymal malignant components. We describe four examples with a focus on the characterization of the epithelial components and the histogenetic implications for this unique tumor. All patients were men aged 40–79 years. All patients developed metastatic disease, and three of them died 4–19 months after the diagnosis. Sarcomatous elements included poorly differentiated spindle cell sarcoma without distinctive differentiation (n = 4), chondrosarcoma (n = 2), and rhabdomyosarcoma (n = 1). In two cases, the sarcomatous component was recognized only in metastatic lesions. Notably, carcinomatous components were characterized by multilineage and primitive cellular differentiation, including carcinoma with enteroblastic (n = 4), hepatoid (n = 3), yolk sac tumor-like (n = 1), trophoblastic (n = 1), and neuroendocrine (n = 1) differentiation, as well as conventional tubular adenocarcinoma (n = 4). On immunohistochemistry, all four cases showed varying degrees of positive expression of primitive phenotypic markers, including alpha-fetoprotein (AFP), glypican-3, or SALL4. All tumors showed mutant patterns of p53 staining, exhibiting either diffusely positive or completely negative staining. On the basis of these findings, at least some gastric carcinosarcomas are likely to be derived from carcinoma with a primitive phenotype, including AFP-producing adenocarcinoma. Our observations suggest that sarcomatous differentiation, as well as multilineage differentiation of epithelial components, may represent increased cellular plasticity of gastric carcinoma with a primitive phenotype.

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Funding

This research was supported by a Grant-in-Aid for Scientific Research (grant no. 19K16581 and 21K06882) from the Japan Society for the Promotion of Science (to Sho Yamazawa and Tetsuo Ushiku).

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  1. Department of Pathology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Sho Yamazawa & Tetsuo Ushiku

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  1. Sho Yamazawa
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Sho Yamazawa: methodology, investigation, resources, writing-original draft, visualization, and funding acquisition. Tetsuo Ushiku: conceptualization, writing-reviewing and editing, visualization, supervision, and funding acquisition.

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Correspondence to Tetsuo Ushiku.

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Our study was approved by the institutional review board of Tokyo University Hospital, Tokyo, Japan (protocol no. 10461; 21 April 2014).

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Yamazawa, S., Ushiku, T. Carcinosarcoma of the stomach: four cases that expand the morphologic spectrum of gastric cancer with a primitive phenotype. Virchows Arch 480, 1051–1062 (2022). https://doi.org/10.1007/s00428-022-03307-6

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