title: Evidence for colorectal sarcomatoid carcinoma arising from tubulovillous adenoma.
abstract: Sarcomatoid carcinomas of the colorectum are rare tumors that display both malignant epithelial and stromal components. Clinically, they are aggressive tumors with early metastasis. Due to their infrequent occurrence, the pathogenesis is poorly understood. We report a case of a 52-year-old woman who presented with a rectal mass and intermittent hematochezia. Superficial biopsies during colonoscopy revealed a tubulovillous adenoma with high-grade dysplasia. Endoscopic ultrasonography confirmed an invasive nature of the mass, and deeper biopsies revealed the presence of neoplasm with mixed histological components. The surgically-excised specimen demonstrated the presence of poorly differentiated spindle cells underneath the tubulovillous adenoma and an intermediate stage of invasive adenocarcinoma. Based on the histological appearance and immunohistochemical studies, a diagnosis of sarcomatoid carcinoma was made. Only nine cases of sarcomatoid carcinomas of the colorectum have been reported to date. As a result, the terminology and pathogenesis of sarcomatoid carcinoma remain speculative. To the best of our knowledge, this is the first report of co-existence of sarcomatoid carcinoma and invasive adenocarcinoma with tubulovillous adenoma; all stages represented within the same tumor. This observation supports the "monoclonal theory" of pathogenesis with an adenoma-sarcoma progression with or without an intermediate stage of carcinoma.
authors.affiliation: Department of Medicine, University of California, San Diego UC 303 (MC 0063), 9500 Gilman Drive, La Jolla CA 92093-0063, United States.
authors.forename: Jeffrey-K
authors.initials: JK
authors.lastname: Lee
authors.forename: Pradipta
authors.initials: P
authors.lastname: Ghosh
authors.forename: Valerie
authors.initials: V
authors.lastname: McWhorter
authors.forename: Misty
authors.initials: M
authors.lastname: Payne
authors.forename: Ryan
authors.initials: R
authors.lastname: Olson
authors.forename: Mary-L
authors.initials: ML
authors.lastname: Krinsky
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
authors.forename: John-M
authors.initials: JM
authors.lastname: Carethers
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D004724:Endoscopy; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012509:Sarcoma / Q000175:diagnosis / Q000473:pathology*