Abstract
PurposeGastric sarcomatoid carcinoma (GSC) is a very rare malignant tumor. The purpose of this study is to describe the clinical, computed tomography (CT), and pathologic features of GSC to increase awareness of this entity.MethodsThe CT features and clinical data of five patients with pathologically documented GSC were retrospectively analyzed and compared with the corresponding data of gastric adenocarcinoma and lymphoma.ResultsAmong the 5 patients, 4 were male, and 1 was female. The median age was 59 years. Of the 5 cases of GSC, 3 were in the gastric fundus and cardia, 1 was in the gastric body, and 1 was in the gastric fundus. The gastric wall had local thickening in 4 cases and mass formation in 1 case, with stenosis and deformation of the adjacent gastric cavity. The long-axis diameter of the lesions ranged from 1.4 to 10.2 cm (mean, 4.97 cm) and was <10 cm in 4 cases and >10 cm in 1 case. The tumor showed predominantly inhomogeneous density, with radiodensity values ranging from 30 to 53 HU. In addition, ulcers with an irregular base and slightly raised borders were observed in 4 of 5 cases. After an injection of contrast material, heterogeneous (n = 4) or homogeneous (n = 1) enhancement was observed. After contrast medium injection, obvious enhancement was seen in 2 cases, and moderate enhancement was seen in 3 cases; the peak tumor signal was observed in the portal phase. Two of the patients demonstrated evidence of lymph node involvement, and in one patient, the boundary between the lesion and the left lobe of the liver was unclear, with low attenuation in the right lobe of the liver with circular enhancement. The remaining two patients showed no evidence of metastasis.ConclusionAlthough GSC is extremely rare, it should be considered in the differential diagnosis of gastric adenocarcinoma and lymphoma. CT findings, combined with patient age and sex, can provide support for the diagnosis of GSC. However, the final diagnosis must be confirmed with histopathology.
Highlights
Sarcomatoid carcinomas (SCs) are extremely rare aggressive malignant tumors characterized by distinct cellular morphology [1]
Due to the more invasive nature and poorer prognosis of gastric sarcomatoid carcinoma (GSC) than pure gastric adenocarcinoma (GAC) and gastric lymphoma (GL), it is clinically beneficial to narrow down the differential diagnoses by understanding the computed tomography (CT) characteristics of GSC
Based on systematic research of this rare tumor and comparisons with common gastric cancers, we found that GSC is more common in men who are approximately 60 years old and is often accompanied by ulcers
Summary
Sarcomatoid carcinomas (SCs) are extremely rare aggressive malignant tumors characterized by distinct cellular morphology [1]. The features of this tumor were first described in 1982 by Snover et al [2]. SCs can occur in a wide variety of sites, including the respiratory tract, digestive tract, genitourinary tract, breast and thyroid glands [3] These tumors are rare in the digestive tract, especially in the stomach. As of April 2020, there are only six cases of gastric sarcomatoid carcinoma (GSC) reported in the English medical literature These previous reports focused on the pathological and clinical manifestations; them have not systematically described the radiologic appearance of the tumor. To the best of our knowledge, our study represents the largest series of GSCs to date
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