Cutaneous Carcinosarcoma

Katy H. Goldsborough, William B. Laskin, Jeffrey D. Wayne, Mark Agulnik

Department of Medicine, Division of Hematology/ Oncology,Department of Pathology

Department of Surgery, Division of Surgical Oncology

Feinberg School of Medicine,Northwestern University,

Chicago, IL

Carcinosarcomas (CS): Background

• Malignant neoplasm– Biphasic epithelial and mesenchymal

elements– Breast, lung, urogenital, gastrointestinal– Hypothesis- Multiclonal vs. Monoclonal– IHC studies establish 2 distinct populations

• Primary cutaneous CS– Dawson 1972– Basal and squamous cell carcinoma– Pleomorphic/ atypical fibroxanthoma/ MFH

Case Report

• 62 y.o. male• Subcutaneous 4 mm nodule lateral to sternum• Slow growth over 18 months• Excisional bx followed by wide local excision

p63 AE1/AE3

Cam 5.2

CK 5/6

BetaE12/CK903

MNF116 Vimentin S100

BCC + + + + + + - -

Sarcoma - - - - - - + -

Methods

• All case reports and series of CCS

• Search terms:» Carcinosarcoma» Carcinoma and sarcoma» Sarcomatous sarcoma» Biphasic sarcomatoid carcinoma» Spindle cell carcinoma

• 48 publications reviewed

Results• Between 1972 and 2007: 74 cases of CCS have

been reported.Sex- M:F 49:25

Age Range (Mean) 36-93 (71)

Duration

< 3 months

3-6 months

> 6 -12 months

1-2 years

> 2 years

NR/UK

6 weeks- 50 yrs

10

6

5

5

22

26

Size

< 1 cm

1-5 cm

>5-10 cm

> 10 cm

NR/ UK

9

42

13

4

6

EpithelialBCC

SCC

Spiroadenocarcinoma

Pilar Tumor

Pilomatrix Carcinoma

Porocarcinoma

Adenocarcinoma

37

20

11

6

1

1

3

MesenchymalAngiosarcoma

Chondrosarcoma

Fibrosarcoma

Leiomyosarcoma

Osteosarcoma

Pleomorphic

Rhabdomyosarcoma

Spindle cell Sarcoma

1

7

1

5

24

32

4

12

ResultsTreatment Surgery 74

Radiation 10

Chemotherapy 2

Survival AWOD

<6 months

6-12 months

>12 months

38

4

13

21

DWOD

< 12 months

>12 months

7

1

6

AWD

< 12 months

> 12 months

5

3

2

DWD

< 12 months

> 12 months

11

9

2

Unknown 13

Conclusions

• Primary CCS is a rare disease.• 6th-8th decade of life• Survival predicted by:

– Epithelial component– Growth pattern– Tumor size– Duration– LN involvement– Age

Conclusions

• Treatment approach– Wide local excision– Negative margins

• No defined role for adjuvant radiation therapy or chemotherapy.