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