multiple adenocarcinomas and synchronous leiomyosarcoma of the colon: a case report m.c. de nisi,...
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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
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CLINICAL PRESENTATION
73 YEAR OLD MAN WITH OBSTRUCTIVE NEOPLASM
NO CANCER PREDISPOSITION SYNDROME
NO PREGRESS NEOPLASM REFERRED
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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
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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
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DIFFERENTIAL DIAGNOSIS
???? COLLISION TUMOURS
OR
ADENOCARCINOMA WITH SARCOMATOID
DIFFERENTIATION ???
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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)
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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)
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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)
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MORPHOLOGY
THE NEOPLASM WAS COMPOSED OF A DISCRETE SARCOMATOUS AND GLANDULAR COMPONENT WITH NO MORFOLOGICAL “TRANSITION” BETWEEN THE TWO DIFFERENT NEOPLASTIC TISSUES
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MORPHOLOGY
4x 40x
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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.
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IMMUNOPHENOTYPE
AE1AE3
CEA-P
Vimentin
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CONCLUSION
MORPHOLOGICAL ANDIMMUNOISTOCHEMICALRESULTS RULED OUTTHE DIAGNOSISOF CARCINOSARCOMA OR METAPLASTIC ADENOCARCINOMA WHILE SUPPORTED THE HYPOTHESIS OF TWODIFFERENT NEOPLASTIC CLONES
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DIAGNOSIS
LOW GRADE LEOMYOSARCOMA
SYNCHRONOUS WITH
TWO INFILTRATING
ADENOCARCINOMAS
AND MULTIPLE ADENOMAS
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THANKS FOR YOUR ATTENTION