cutaneous carcinosarcoma katy h. goldsborough, william b. laskin, jeffrey d. wayne, mark agulnik...
DESCRIPTION
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 p63AE1/ AE3 Cam 5.2 CK 5/6 BetaE12/ CK903 MNF116VimentinS100 BCC SarcomaTRANSCRIPT
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 months3-6 months
> 6 -12 months1-2 years> 2 years
NR/UK
6 weeks- 50 yrs10655
2226
Size< 1 cm1-5 cm
>5-10 cm> 10 cmNR/ UK
9421346
EpithelialBCCSCC
SpiroadenocarcinomaPilar Tumor
Pilomatrix CarcinomaPorocarcinoma
Adenocarcinoma
3720116113
MesenchymalAngiosarcoma
ChondrosarcomaFibrosarcoma
LeiomyosarcomaOsteosarcoma
PleomorphicRhabdomyosarcomaSpindle cell Sarcoma
1715
24324
12
ResultsTreatment Surgery 74
Radiation 10
Chemotherapy 2
Survival AWOD<6 months
6-12 months>12 months
384
1321
DWOD< 12 months>12 months
716
AWD< 12 months> 12 months
532
DWD< 12 months> 12 months
1192
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.