1254 Sarcomatoid Carcinoma of the Head of the Pancreas: A Rare Case

INTRODUCTION: To the best of our knowledge, a total of 23 cases of sarcomatoid or carcinosarcoma of the pancreas have been reported. 1 Sarcomatoid carcinoma of the pancreas (SCP) is a rare and aggressive malignant neoplasm with evidence of epithelial and mesenchymal features. Confirmation of this disease currently relies on detailed pathologic examinations. SCP is comparatively more aggressive with a poorer prognosis than that of conventional pancreatic carcinomas. Therefore, SCP can be a challenge both diagnostically and therapeutically for clinicians and surgeons alike. The presenting case illustrates and highlights potential indications that can be used to diagnose and treat SCP much earlier than conventional medicine currently allows. CASE DESCRIPTION/METHODS: We present a case of SCP in an 84-year-old male patient. He had experienced jaundice and epigastric abdominal pain for 4 weeks. An ultrasound revealed a hypoechoic mass at the pancreatic head which prompted referral to our gastroenterology group. Physical examination revealed scleral icterus, cutaneous jaundice, and left hip and lower back pain. Laboratory tests yielded the following results: total bilirubin of 13.4 U/L, AST/ALT of 171 U/L and 240 U/L respectively, and an alkaline phosphatase of 714 U/L. Imaging examinations were performed including MRCP, EUS, and CT noting a mass in the pancreatic head. Due to the aggressiveness of this patient's tumor and despite medical efforts, the patient succumbed to his illness shortly after the official diagnosis was discovered and before any therapeutic measures could have been initiated. DISCUSSION: Our final diagnosis of SCP was made via pathologic examination as high-grade malignant sarcomatoid neoplasm with spindled areas, ample mitosis, and necrosis. IHC analysis showed positive expression for cytokeratin, vimentin, CD56, and a Ki-67 with a proliferative rate of greater than 90%. Other immunomarkers for melanoma, smooth muscle, and lymphoma were negative. These findings are indicative of sarcomatoid morphology and phenotype. Although definitions of SCP vary, it is believed that SCP features spindle cells and possesses mesenchymal-like and epithelial-like appearances. 1 Due to the histological report of spindle cell patterns and the co-presence of mesenchymal-like and epithelial-like cells illustrated using immunostaining techniques, our case is most consistent with SCP.