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sarcomatoid prostate acinar adenocarcinoma

Sunday 12 February 2012

Sarcomatoid variant (carcinosarcoma)

There is considerable controversy in the literature regarding nomenclature and histogenesis of these tumours. In some series, carcinosarcoma and sarcomatoid carcinoma are considered as separate entities based on the presence of specific mesenchymal elements in the former.

However, given their otherwise similar clinico-pathologic features and identically poor prognosis, these two lesions are best considered as one entity.

Sarcomatoid carcinoma of the prostate is a rare neoplasm composed of both malignant epithelial and malignant spindle-cell and/or mesenchymal elements.

Sarcomatoid carcinoma may be present in the initial pathologic material (synchronous presentation) or there may be a previous history of adenocarcinoma treated by radiation and/or hormonal therapy.

The gross appearance often resembles sarcomas.

Microscopically, sarcomatoid carcinoma is composed of a glandular component showing variable Gleason score.

The sarcomatoid component often consists of a nonspecific malignant spindle-cell proliferation.

Amongst the specific mesenchymal elements are osteosarcoma, chondrosarcoma, rhabdomyosarcoma, leiomyosarcoma, liposarcoma, angiosarcoma or multiple types of heterologous differentiation.

Sarcomatoid carcinoma should be distinguished from the rare carcinoma with metaplastic, benignappearing bone or cartilage in the stroma.

By immunohistochemistry, epithelial elements react with antibodies against PSA and/or pan-cytokeratins, whereas spindle-cell elements react with markers of soft tissue tumours and variably express cytokeratins.

Serum PSA is within normal limits in most cases.

Nodal and distant organ metastases at diagnosis are common.

There is less than a 40% five-year survival.