Bulky peritoneal carcinosarcoma with tiny high-grade serous carcinoma of the fallopian tube: a case report
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CASE REPORT
Bulky peritoneal carcinosarcoma with tiny high‑grade serous carcinoma of the fallopian tube: a case report Ayaka Nakashima1 · Yasuyo Maruyama1 · Haruya Saji2 · Tomoo Hirabuki1 · Hiroyuki Mitomi3 Received: 10 July 2020 / Accepted: 27 September 2020 © The Japan Society of Clinical Oncology 2020
Abstract Peritoneal carcinosarcoma is a highly aggressive and uncommon neoplasm that has carcinomatous and sarcomatous components; the malignancy rarely localizes to the omentum. We report a case of a bulky peritoneal carcinosarcoma with tiny high-grade serous carcinoma of the fallopian tube. A 60-year-old female with a huge pelvic mass (12 cm in diameter) underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy for tumor debulking. Pathological findings showed minimally invasive high-grade serous carcinoma of the left fallopian tube and carcinosarcoma of the omentum. Similar p53 diffuse immunostaining in the omental carcinosarcoma and the tubal carcinoma provides evidence for a clonal relationship between the two neoplasias. This case suggests a small serous carcinoma, originating in the tubal mucosa, subsequently became implanted in the omentum and grew preferentially, converting to a carcinosarcoma at a remote site. Keywords Peritoneal carcinosarcoma · High-grade serous carcinoma · Serous tubal intraepithelial carcinoma · Fallopian tube · p53 · Case report · Conversion theory
Introduction Peritoneal carcinosarcoma is a highly aggressive, relatively unusual neoplasm composed of carcinomatous and sarcomatous components [1–5] that rarely occurs in the omentum [2, 3]. Recent evidence suggests peritoneal carcinoma may be derived from a defined precursor known as serous tubal intraepithelial carcinoma (STIC) of the fimbria of fallopian tube [6–8]. Coexistence of a peritoneal carcinosarcoma with a minute serous carcinoma (STIC) in the fimbria of fallopian tube has been reported [8]. The occurrence of STIC in pelvic carcinosarcoma has also been described [9]. In this latter case, a similar p53 immunostaining pattern and identical
* Ayaka Nakashima [email protected] 1
Department of Obstetrics and Gynecology, Odawara Municipal Hospital, 46 Kuno, Odawara, Kanagawa 250‑8558, Japan
2
Department of Obstetrics and Gynecology, Fujisawa Municipal Hospital, 2‑6‑1 Fujisawa, Fujisawa, Kanagawa 251‑8550, Japan
3
Department of Diagnostic Pathology, Odawara Municipal Hospital, 46 Kuno, Odawara, Kanagawa 250‑8558, Japan
TP53 mutations were detected in the pelvic carcinosarcomas and their associated STICs [9]. Here, we report a rare case of a bulky carcinosarcoma of the omentum and tiny high-grade serous carcinoma of the fallopian tube. Following debulking surgery for omental carcinosarcoma, the patient was treated with paclitaxel–carboplatin adjuvant chemotherapy. We discuss the histogenesis of peritoneal carcinosarcoma, as the tumor may originate from STIC of the fallopian tube.
Case presentation A 60-year-old woman (gravida 2, para 2) presented with a chief complaint
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