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.