Ann Hepatobiliary Pancreat Surg.  2023 May;27(2):141-150. 10.14701/ahbps.22-078.

Collective review of pancreatic carcinosarcoma, a very rare pancreatic malignancy

• Lee M
• Cho YJ
• Jung HS
• Yun WG
• Han Y
• Kwon W
• Jang JY

• KMID: 2542577
• DOI: http://doi.org/10.14701/ahbps.22-078

Abstract

Pancreatic carcinosarcoma is a very rare malignancy with a poor prognosis. Because of these characteristics, a treatment strategy for it has not been established yet. The aim of this study was to establish a therapeutic strategy for pancreatic carcinosarcoma. We reviewed data of a 65-year-old female patient who was diagnosed with pancreatic carcinosarcoma through endoscopic ultrasound-guided fine needle aspiration biopsy before surgery. For literature review, we searched PubMed using terms of “Pancreatic” or “Pancreas” and “carcinosarcoma” or “carcinosarcomatous”. The patient received 11 cycles of neoadjuvant treatment with leucovorin, fluorouracil, irinotecan, oxaliplatin and pembrolizumab because the tumor was borderline resectable. She underwent stereotactic ablative body radiotherapy (SABR) with 35 Gy in 5 fractions, followed by robotic pylorus-preserving pancreaticoduodenectomy. After surgery, the patient received adjuvant chemotherapy in the same regimen as before surgery. She is alive without any recurrence. Among 48 patients within 33 available papers, the median survival time was 15 months. The survival rate of patients who received adjuvant chemotherapy tended to be higher than that of those who did not receive adjuvant chemotherapy, although the difference was not statistically significant (median survival, 47 vs. 15 months; p = 0.485). Three patients who received neoadjuvant chemotherapy had a survival period of 13–23.5 months. Surgery with lymphadenectomy, adjuvant therapy, and neoadjuvant therapy are thought to help improve survival outcomes. Modern treatment approaches for conventional pancreatic ductal adenocarcinoma could be applied to pancreatic carcinosarcoma.

Keyword

Carcinosarcoma; Survival; Pancreas; Neoplasms; Neoplasms, complex and mixed

Figure

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  Fig. 1 Paper selection flow chart for literature review.

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  Fig. 2 Axial view of computed tomography demonstrating a 2.6-cm sized low attenuated mass in the head of the pancreas.

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  Fig. 3 Histopathologic slide of endoscopic ultrasound-guided fine-needle aspiration biopsy. (A) Hematoxylin and eosin staining, (B) cytokeratin immunostaining, and (C) vimentin immunostaining. Original magnification ×40.

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  Fig. 4 Histopathologic slide after surgical resection (original magnification ×40). A, carcinoma component; B, sarcoma component.

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  Fig. 5 Overall survival curve of patients in the literature.

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