Malignant Epithelial Components Research Articles

Clinical, Epidemiological, Morphological, and Immunohistochemical Aspects of Nasopharyngeal Carcinoma-4-Year Retrospective Study in the Western Part of Romania.

Nasopharyngeal carcinoma is one of the most common malignant tumors in the head and neck region. The carcinogenesis is a complex process stimulated by many factors. Although the etiological factors and pathogenic mechanisms are not elucidated, the genetic susceptibility, environmental factors, and association with latent infection with Epstein-Barr Virus play an important role. The aim of this study was to present the main clinical and epidemiological data, as well as the morphological aspects and the immunohistochemical profile, of patients with nasopharyngeal carcinoma diagnosed in western Romania. The study was retrospective and included 36 nasopharyngeal carcinomas. The histopathological diagnosis was completed using immunohistochemical reactions for the following antibodies: p63, p53 and p16 protein, cytokeratins (CK) AE1/AE3, CK5, CK7, CK20 and 34βE12, epithelial membrane antigen (EMA), Epstein-Barr virus (EBV), leukocyte common antigen (LCA), CD20, CD4, CD8, CD68, CD117, and CD1a. The squamous malignant component of nasopharyngeal carcinoma presented with positivity for cytokeratins AE1/AE3, CK5, 34βE12, and p63. Undifferentiated nasopharyngeal carcinoma was positive for EMA in 67% of cases, and 28% of cases showed an immunoreaction for CD117 in the malignant epithelial component. Also, the p53 protein was positive in all the cases. One case of undifferentiated nasopharyngeal carcinoma was p16-positive, and two cases were positive for EBV. A peri- and intratumor cellular infiltrate rich in lymphocytes, with a predominance of CD20-positive B lymphocytes, interspersed with T lymphocytes, was observed. The T cells were CD4- and CD8-positive, predominantly intratumoral, and the CD4:CD8 ratio was 1:1 for 75% of the undifferentiated subtype and 89% for differentiated non-keratinized squamous cell carcinoma. All subtypes of nasopharyngeal carcinoma presented with an inflammatory infiltrate with numerous plasma cells, eosinophils, and dendritic cells, presenting as antigen CD1a- and CD68-positive, as well as in CD117-positive mast cells.

Teratocarcinosarcoma: A rare malignant tumor of sinonasal tract

Sinonasal teratocarcinosarcoma is an extremely rare malignant tumor arising in the sinonasal tract, having combined histological features of teratoma and carcinosarcoma. Here, we are presenting a case of sinonasal teratocarcinosarcoma in a 44 year‑old male patient. 44 year old male presented to us with complains of nasal obstruction and intermittent epistaxis since 1 month. On examination polypoidal mass was noted in left nasal cavity which bleeds on touch. On MRI, well defined heterogeneously enhancing lesion completely filling the left nasal cavity was noted. Histopathological examination of resected specimen revealed, malignant epithelial components being adenocarcinoma and squamous cell carcinoma, mesenchymal component composed of spindle cells, along with primitive mesenchymal and blastemal components. Immunohistochemistry showed epithelial and stromal markers positive for Cytokeratin and Vimentin respectively. Sinonasal teratocarcinosarcoma (TCS) is a rare and aggressive malignant neoplasm characterized by the combination of malignant teratoma and carcinosarcoma. Most common presentation being nasal obstruction and epistaxis with male preponderance. The tumor shows heterogeneous morphology with varying proportions of benign and malignant epithelial, mesenchymal, and blastemal components. Less than 100 cases have been reported in literature. Teratocarcinosarcoma is a rare aggressive sinonasal tumor. Total excision of the tumor and aggressive sampling for histopathological examination is necessary to avoid misdiagnosis of olfactory neuroblastoma and carcinosarcoma.

Genomic and Molecular Characteristics of Ovarian Carcinosarcoma.

Ovarian carcinosarcoma (OCS) is a rare malignancy with a poor prognosis. It is a biphasic tumor with malignant epithelial and mesenchymal components. A few mutations commonly seen in cancer have been identified in OCS, including TP53, PIK3CA, c-myc, ZNF217, ARID1A, and CTNNB1. Some OCS tumors have shown vascular endothelial growth factor positivity and limited HER2 expression. There is evidence of homologous recombination deficiency in OCS. This malignancy can be categorized as copy number high but has not been shown to have a high tumor mutational burden. There are mixed findings regarding the presence of biomarkers targeted by immune checkpoint inhibitors in OCS. For treatments other than systemic chemotherapy, the data available are largely based on in vitro and in vivo studies. In addition, there are case reports citing the use of poly-ADP ribose polymerase inhibitors, vascular endothelial growth factor inhibitors, and immunotherapy with varying degrees of success. This review paper will discuss the molecular and genomic characteristics of OCS, which can guide future treatment strategies.

Effusion cytology of metastatic carcinosarcoma.

Carcinosarcomas (CSs) are rare gynecological neoplasms seen in elderly females. These are composed of malignant epithelial and mesenchymal components, which appear as adenocarcinoma and high-grade sarcoma. Effusions are encountered uncommonly in CS. The study focuses on the cytomorphology of 10 cases of metastatic CS in effusions. In 6 years, there were 10 (0.45%) cases of metastatic CS in effusion samples out of 2240 malignant effusion samples. The samples were processed by SurePath™ and centrifuge technique. Both May-Grünwald-Giemsa and Papanicolaou stained smears were evaluated for cytomorphological features, and the findings were correlated with subsequent histopathology. The cells were predominantly arranged in ball-like clusters and discretely. The cells had abundant vacuolated cytoplasm and enlarged pleomorphic nuclei. Occasional cases showed scattered spindle cells. The cases were diagnosed as metastatic adenocarcinoma (7/10) and positive for malignant cells (3/10). None of the cases was diagnosed as CS. The primary of these cases was in the uterus (7/10) and ovary (3/10). The cytological evaluation of such effusion samples rarely demonstrates the classical biphasic pattern of these tumors. Mostly, the carcinomatous component is evident, and the sarcomatous element is inapparent and readily missed.

Carcinosarcoma of Uterus – A Case Report and Review of Literature

Postmenopausal bleeding is a symptom that needs careful history taking, thorough clinical examination and further radiological investigations. Carcinosarcoma is an aggressive malignant neoplasm of the uterine corpus composed of malignant epithelial and mesenchymal components. We report a rare case of 75-year-old post-menopausal woman with post-menopausal bleeding diagnosed with carcinosarcoma of uterus. This case report emphasises the importance of typical clinical history, clinical findings and gross findings of carcinosarcoma for early clinical diagnosis.

Malignant cutaneous mixed tumour arising on the upper back: a case report

Background: Malignant adnexal tumours are a heterogenous group of rare neoplasms comprising <0.002% of skin cancers.1 Cutaneous mixed tumour (chondroid syringoma) is an adnexal neoplasm with epithelial and mesenchymal elements. Its malignant counterpart has both a malignant epithelial component and areas of chondroid and myxoid differentiation.2 Malignant transformation is rare with limited reports in the literature.

The prognostic significance of the heterologous component in uterine carcinosarcomas.

Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.

Unusual liver Involvement by Small Cell Carcinoma Arising in an Ovarian Malignant Mixed Mullerian Tumor

Abstract Introduction/Objective Malignant mixed Mullerian tumor (MMMT) is a rare and aggressive tumor with patient survival of fewer than three years. MMMT harbors multilineage differentiation associated with malignant epithelial and stromal components. Awareness and familiarity with these characteristics are essential for patient stratification and clinical management. Methods/Case Report A 64-year-old female presented with refractory lower abdominal pain and bloating. Imaging studies revealed a 14-cm pelvic mass. The patient underwent urgent hysterectomy with salpingo-oophorectomy. She was diagnosed with ovarian MMMT(A) and received chemotherapy. The patient returned 2 months later with new- onset abdominal pain. CT detected numerous liver lesions; a biopsy was performed. Results (if a Case Study enter NA) The liver biopsy revealed metastatic small cell carcinoma (SCC[B], positive for synaptophysin and CD56; Ki67 &amp;gt;90%.). However, no concurrent lesions were identified on imaging. Further testing was attempted to locate the source of the SCC. Re-review of the MMMT with additional tissue sectioning identified sheets of high-grade pleomorphic malignant cells with a high N:C ratio, arranged in rosettes and without mucin. Additional immunohistochemistry labeled this MMMT diffusely with synaptophysin(C), chromogranin, and CD56. Furthermore, microscopic foci of MMMT showed higher grade histomorphology similar to the liver SCC which stained for PAX5(D). These findings illustrate a rare MMMT with a neuroendocrine carcinoma/SCC component which gave rise to liver metastasis. Conclusion This unusual liver SCC in a patient with prior MMMT exemplifies the multipotent malignant potential of MMMT and demonstrates the importance of having a spectrum of differentials and carrying out meticulous histomorphologic and ancillary analyses, especially when there is unusual histomorphology and discordance in clinical course.

Molecular Evidence for Epithelial Origin of Mixed Ovarian Epithelial-Germ Cell Neoplasms: Report of 2 Cases and Review of Literature.

Ovarian germ cell tumors (GCT) account for 2% to 3% of malignant ovarian neoplasms in Western countries and typically occur within the first 2 decades. When presenting later in life, GCTs may be associated with epithelial malignancies. In these circumstances, it has been theorized that these tumors may originate from a somatic, rather than germ cell origin, especially in the postmenopausal setting; however, the true derivation is not fully understood. Our database was searched for primary ovarian GCTs associated with a malignant epithelial component in patients above 35yr of age, from 2006 to 2021. Two cases were identified and in each case, slides were reviewed and targeted next-generation sequencing was utilized to identify and compare gene mutation variants in morphologically distinct components. Patient A is a 58-yr-old, with choriocarcinoma and minor component of mucinous adenocarcinoma, and patient B is a 43-yr-old, with yolk sac tumor and minor component of endometrioid adenocarcinoma. The morphologically distinct areas in each case showed disparate staining patterns; however, next-generation sequencing demonstrated identical mutation variants within both the germ cell and epithelial components. Variants in CDKN2A, PIK3CA, PIK3R1, and TP53 were present in patient A's tumor, while patient B's tumor showed CTNNB1, PIK3R1, and 2 PTEN variants. These mutational patterns are similar to those seen in pure epithelial counterparts, suggesting somatic derivation of the germ cell component. These rare tumors portend a poor prognosis and understanding their origin has clinical and therapeutic implications.

The histological and immunohistochemical features of a metastatic mammary carcinosarcoma in a dog - a case report

A carcinosarcoma is a tumor composed of cells morphologically resembling both malignant epithelial and mesenchymal components. An 11-year-old, female, mixed-breed terrier was referred to the clinic with complaints of anorexia, vomiting and exercise intolerance. Clinically, tumoral masses were seen in the mammary glands. During necropsy, multilobulated calcified masses were observed in several visceral organs (the liver, kidneys, lungs, small intestines, lymph nodes and thyroid) and both right and left (3rd and 4th) mammary glands. Immunohistochemically, Thyroglobulin, SMA, TTF-1, S100, CD34, and p53 were negative in both epithelial and mesenchymal areas, however, Ki-67 showed high proliferation, especially in the mesenchymal areas. While the positivity of vimentin expression was high in the mesenchymal component of the tumor, the positivity of cytokeratin (CK7 and CK19) expressions was high in the epithelial component of the tumor. In the case of a carcinosarcoma, there is a probability that not only the carcinomatous part, but also the sarcomatous part will metastasize. Despite being uncommon, canine carcinosarcomas should always be considered in the differential diagnosis of mixed mammary tumors, if they include both components. There have not been many previous studies dealing with the metastasis of a mammary carcinosarcoma in dogs as an aggressive tumor. Therefore, we consider this report a worthy contribution and have defined the multiple organ metastasis of a mammary carcinosarcoma.

A Case Report on: CA Bladder

Introduction: Urinary bladder cancer is a global health problem. Carcinosarcoma of bladder is a very rare abnormal growth of cells and tissues called as tumors and it consist of malignant epithelial and sarcomatoids components. It mostly occurs at aging. Presentation of disease with hematuria i.e. blood in urine and painful urination i.e. dysuria. Pelvic radiation and cyclophosphamide therapy are the risk factors responsible for carcinoma of bladder.&#x0D; Clinical Findings: Severe abdominal pain, fever (Temperature- 1000 F), weakness, Anemia (Hemoglobin- 10.6gm %).&#x0D; Diagnostic Evaluation: Blood test Hemoglobin -10.6 gram %, Total Red blood cell count- 3.4 million/cumm, Hematocrit- 21.45, Total White blood cells count- 12,000 per microliter. In ultrasonography it was found that, a mass present on the right lateral wall of the urinary bladder.&#x0D; Therapeutic Intervention: Hemoglobin was raised by blood transfusion, Inj. Ceftriaxone 1gm Intravenously BD, Inj. Pantoprazole 40 mg Intravenously BD, radiation therapy and chemotherapy.&#x0D; Outcome: As compared to prior condition patient’s present condition show improvement. Fever was reduced and relieved abdominal pain by treatment and procedure transurethral resection of bladder tumor. With the help of blood transfusion Hemoglobin % increased from 10.6 to 11.5gm%.&#x0D; Conclusion: My client was admitted to female surgery ward, at Acharya Vinoba Bhave Rural Hospital Sawangi (Meghe), Wardha with an unknown case of Ca bladder. On admission her condition was poor. So on clinical manifestation, specific and routine investigation was done and after proper treatment her condition was found improved than previous. Here we have to emphasize on early diagnosis and proper treatment strategies helps to improve patient’s prognosis. It also helps to prevent morbidity and mortality.

SALL-4 and Beta-Catenin Expression in Sinonasal Teratocarcinosarcoma.

Sinonasal teratocarcinosarcoma (SNTCS) is a rare, aggressive malignancy that displays a heterogeneous combination of malignant blastema-like, epithelial and mesenchymal components. Its exact histogenesis is unknown with hypotheses ranging from true germ cell derivation to origin from pluripotent stem cells. However, despite this tumor's multiphenotypic histology, which includes frequent glandular, squamous, and neuroectodermal differentiation similar to adnexal germ cell tumors, SNTCS appears to have some differences from adnexal teratomas. For example, unlike adnexal teratomas, SNTCS has never been described as a component in a mixed germ cell tumor. Accurate recognition of SNTCS is difficult due to its rarity and histologic overlap with other sinonasal tumors. It is even more problematic on biopsy, since not all elements may be present in small samples. SNTCS can also share similar staining patterns with other neoplasms in the differential diagnosis. A recent study found nuclear β-catenin expression in a single TCS, but this has yet to be confirmed in additional cases. SALL-4, a marker of germ cell tumors, has not been examined. We performed β-catenin and SALL-4 immunohistochemistry on whole sections of 7 SNTCS and 19 other sinonasal neoplasms to assess whether β-catenin and SALL-4 are of utility in establishing a diagnosis of SNTCS. Intensity of expression and percentage of staining was noted for each tumor. For SNTCS, distribution of staining within each histologic component (immature neuroectodermal, epithelial, and mesenchymal) was also documented. Nuclear β-catenin expression was not identified in any SNTCS, with all cases demonstrating membranous expression (6 cases) or cytoplasmic and membranous expression (1 case). SALL-4 immunohistochemistry, however, was relatively sensitive (85.7%) and specific (89.5%) for SNTCS. SALL-4 expression was also identified in one poorly differentiated neuroendocrine carcinoma and one case of sinonasal undifferentiated carcinoma. SALL-4 appears to have utility in distinguishing SNTCS from other high grade sinonasal tumors.

Clinical analysis of 14 cases of head and neck carcinosarcoma

Objective: To investigate the clinicopathological characteristics, treatment and prognosis of head and neck carcinosarcoma. Methods: The clinical data of 14 patients with head and neck carcinosarcoma treated in the First Affiliated Hospital of Zhengzhou University from January 2010 to May 2020 were retrospectively analyzed, including 11 males and 3 females, with age range from 30 to 72 years old. Clinicopathological characteristics, treatments and follow-up results of patients were evaluated. Kaplan-Meier method was used to estimate the cumulative survival rate. Results: Histopathological examination showed the co-existence of malignant epithelial and mesenchymal components in all cases. Immunohistochemical staining of 13 cases showed cytokeratin and epithelial membrane antigens were positively expressed in the epithelial areas, whereas vimentin was positive in the malignant mesenchymal tissue area. Among 14 cases, 5 cases were treated with surgery, 3 cases with surgery and radiotherapy, and 6 cases with surgery, radiotherapy and chemotherapy. The follow-up time was 2-81 months, with a median follow-up time of 22.5 months. Except for one patient who was lost to follow-up in 21 months after treatment, among the remaining 13 patients, 4 patients had recurrence, 8 patients died, and 5 patients had a tumor-free survival. The Kaplan-Meier analysis showed that the 1, 3, and 5-year cumulative survival rates of 14 patients with head and neck carcinosarcoma were 64.3%, 57.1%, and 42.9%, respectively. Conclusions: Carcinosarcoma of the head and neck is rare in clinic, histopathological and immunohistochemical examinations are important basis for diagnosis, and surgery is a preferred treatment. Carcinosarcoma of the head and neck has a poor prognosis, and patients should be followed up for a long time.

Multifocal sarcomatoid urothelial carcinoma of the renal pelvicalyceal system and ureter: A diagnostic dilemma

Sarcomatoid urothelial carcinomas (SUCs) are characterized by intimately mixed malignant epithelial and malignant mesenchymal components. We present a case of a multifocal SUC in the left pelvicalyceal system of the kidney and the left ureter. SUC although rare should be included in the differential diagnosis of multifocal tumors of the renal pelvis and ureter. Immunohistochemistry is essential to confirm the diagnosis and rule out other differentials including pure sarcoma, sarcomatoid variant of renal cell carcinoma, and pseudosarcomatous mesenchymal proliferation.

Carcinosarcoma of the Pancreas with Longer Survival: A Case Report and Literature Review

BackgroundCarcinosarcoma is a rare type of malignant tumor that can occur at various organs, such as the digestive tract, lung, and mammary glands (1-4). Carcinosarcoma of the pancreas is an extremely rare and complicated malignant neoplasm, with the characteristics of high invasiveness and rapid progression, early metastasis, and poor prognosis (4).Case PresentationWe reported a 75-year-old male patient who was admitted with the chief complaint of intermittent pain in the right upper abdomen for more than one month. Computed tomography scans revealed a space-occupying lesion located in the tail of the pancreas considering pancreatic carcinoma. The patient underwent surgical resection of the tumor. Macroscopic observations showed a mass of approximately 6 cm × 5 cm with grayish-white cut surface. Histological analysis showed a large amount of abnormal differentiated epithelial cells and spindle cells. The immunohistochemistry results demonstrated biphasic neoplasm with both malignant epithelial and mesenchymal components. Then, the patient was diagnosed with carcinosarcoma of the pancreas. Although pancreatic carcinosarcoma was considered to have a poor outcome as previously reported, the patient was free of recurrence for 15 months after the surgery, a longer tumor-free survival recorded for this type of cancer, maybe because the patient received gemcitabine adjuvant chemotherapy after the surgery. The current literature shows that the longest postoperative survival time is 26 months (5).ConclusionsCarcinosarcoma of the pancreas is a rare tumor. Surgery is the main way of treatment, and chemotherapy can delay tumor development to some extent.

Landscape of Immune Checkpoint Inhibition in Carcinosarcoma (MMMT): Analysis of IDO-1, PD-L1 and PD-1

BackgroundCarcinosarcoma (CS) or malignant mixed Müllerian tumor (MMMT), is a rare malignant biphasic tumor, which contains both a malignant epithelial and mesenchymal component. That being said, they have an aggressive clinical course. Given that immune checkpoint inhibitors have mustered significant excitement in the oncology world - immunotherapy could offer significant promise to this poor prognostic cancer subtype. A total of 75 carcinosarcoma cases were identified in our institutional database from 2010 to 2019 and immunohistochemistry for PD-L1, PD-1 and IDO-1 was performed. Out of the 75 patients, 65(87 %) demonstrated >1 % PD-1 expression and 50(67 %) expressed >1 % PD-L1 in either the tumoral and immune stromal components. 29 (39 %) cases demonstrated >20 % PD-1 expression and 14 (19 %) cases expressed >20 % PD-L1. 41(55 %) cases demonstrating co-expression of PD-1 and PD-L1. For IDO-1 64 (85 %) patients showed at least >5 %, while 34 (45 %) showed staining above 20 %. 45 patients (60 %) showed co-expression of IDO-1 and PD-L1, while 59 (79 %) patients had co-expression of IDO and PD-1 above 5 and 1 % respectively. Regarding clinicopathologcial features; older patients (> 65) were more likely to express PD-L1 (>1 %) and IDO-1 (>20 %). For tumor size, IDO-1 expression (>5 %), along with PD-1/IDO-1 Co-expression (>1/5 %), was associated with larger tumor size (>5cm). For myometrial invasion, CSs with >50 % invasion were more likely to express IDO-1 (>20 %) and PD-1/IDO-1 (>1/5 %). Ultimately, the effect of IDO-1, PD-1 and PD-L1 on the clinical profile may be less important than its potential use as a immunotherapeutic, where safe and effective corresponding drugs could be used to treat particular patient populations. Future clinical trials are needed to decipher the association between immune check point inhibitor expression and therapeutic response. This is the only way to definitively prove immune checkpoint immunohistochemistry as predictive biomarkers in this cancer subtype.

Pulmonary Blastoma in an adult male

Pulmonary blastoma is one of the rare lung tumors and is considered to be distinct from other lung tumors by its pathological features, clinical course and prognosis [1]. Classic pulmonary blastoma is composed of both malignant mesenchymal stroma and epithelial components resembling embryonic lung tissue. Surgery is the standard treatment and the efficacy of adjuvant chemotherapy and radiotherapy has not yet been established [2]. Case Report Our patient was admitted and managed at Abassia Pulmonary Hospital, Ministry of Health, Cairo Governorate, Egypt. A 37-year-old Egyptian male presented to our hospital after repeated attacks of blood tinged sputum. The first attack dated about 6 months before admission. The patient had progressive shortness of breath over a period of two years. The patient was a smoker of one pack of cigarettes per day for more than 15 years. There was no significant past history nor family history. After admission to the Chest Medicine Department at Abbasia Pulmonary Hospital, routine basic investigations were done including complete blood picture with differential count, fasting blood sugar and 2 hours after meal, liver function tests, renal function tests, and coagulation profile. All investigations were within normal.

Pulmonary blastoma in an adult male

Pulmonary blastoma is one of the rare lung tumors and is considered to be dissnct from other lung tumors by its pathological features, clinical course and prognosis.1 Classic pulmonary blastoma is composed of both malignant mesenchymal stroma and epithelial components resembling embryonic lung tissue. Surgery is the standard treatment and the efficacy of adjuvant chemotherapy and radiotherapy has not yet been established

Fbxw7 is a driver of uterine carcinosarcoma by promoting epithelial-mesenchymal transition

Uterine carcinosarcoma is an aggressive variant of endometrial carcinoma characterized by unusual histologic features including discrete malignant epithelial and mesenchymal components (carcinoma and sarcoma). Recent studies have confirmed a monoclonal origin, and comprehensive genomic characterizations have identified mutations such as Tp53 and Pten However, the biological origins and specific combination of driver events underpinning uterine carcinosarcoma have remained mysterious. Here, we explored the role of the tumor suppressor Fbxw7 in endometrial cancer through defined genetic model systems. Inactivation of Fbxw7 and Pten resulted in the formation of precancerous lesions (endometrioid intraepithelial neoplasia) and well-differentiated endometrioid adenocarcinomas. Surprisingly, all adenocarcinomas eventually developed into definitive uterine carcinosarcomas with carcinomatous and sarcomatous elements including heterologous differentiation, yielding a faithful genetically engineered model of this cancer type. Genomic analysis showed that most tumors spontaneously acquired Trp53 mutations, pointing to a triad of pathways (p53, PI3K, and Fbxw7) as the critical combination underpinning uterine carcinosarcoma, and to Fbxw7 as a key driver of this enigmatic endometrial cancer type. Lineage tracing provided formal genetic proof that the uterine carcinosarcoma cell of origin is an endometrial epithelial cell that subsequently undergoes a prominent epithelial-mesenchymal transition underlying the attainment of a highly invasive phenotype specifically driven by Fbxw7.

Sarcomatoid carcinoma of the urinary bladder: A case report and short review of the literature

Although the most common malignant formations in the bladder are urothelial carcinomas, there are also tumors with different differentiation degrees like sarcomatoid carcinoma of the urinary bladder. It is a rare and highly aggressive type of tumor and consists of malignant epithelial and sarcomatous components. The literature about the subject is extremely limited, and there is no consensus on treatment protocols. This case report aims to present a case of 71-year-old man who presented with macroscopic hematuria and diagnosed with sarcomatoid carcinoma of the urinary bladder.