Cutaneous carcinosarcoma: a rare diagnosis.

Carcinosarcoma is a rare malignant tumor that is a combination of carcinoma (cancer of epithelial tissue) and sarcoma (cancer of mesenchymal tissue). In practice, it is more common to have either carcinoma or sarcoma individually, but it is novel to have a combination of the two; as a result, few cases have been reported. Carcinosarcoma typically occurs in visceral organs and is rare in the skin. We present the case of a 68-year-old man with a lesion on his left zygomatic cheek that was revealed to be a biphasic malignant neoplasm. Multiple stains provided evidence of both epithelial and mesenchymal components within the lesion. Treatment for such a diagnosis typically involves a combination of wide local excision or plastic surgery for reconstruction purposes, both of which were used with this patient. This case describes the identification of cutaneous carcinosarcoma using immunohistochemical tests and emphasizes the uniqueness of such a diagnosis that requires early attention and appropriate selective treatment.

Trichoblastic carcinosarcoma of the neck: Case report and molecular analysis of a seldom, relapsing entity and a review of the literature.

Trichoblastic carcinosarcoma is a seldom biphasic adnexal tumor with malignant epithelial and mesenchymal components. The authors report the first tumor on the neck developed from preexistent trichoblastoma showing aggressive, recurrent behavior. An 82-year-old man presented with a solitary 3-cm exophytic lesion. Histology verified the diagnosis of trichoblastic carcinosarcoma. Four years earlier, a trichoblastic carcinoma arising in a preexisting trichoblastoma was excised at the same location. Despite successful surgical treatments, three local recurrences within 4 years were diagnosed. After the second relapse, the patient agreed on adjuvant radiation. Twelve months later, another relapse was excised in toto. In the last surgical specimen, only the mesenchymal component was found. Copy number variation analysis of the preexisting tumor and two recurrences revealed the same entity and additional chromosomal aberrations in the recurrences. Adnexal carcinosarcomas are seldom, yet presumably underdiagnosed biphasic tumors with aggressive growth potential. They should have adequate preoperative clarification with wide tumor excision, as radiosensitivity seems to be of limited effect.

A primary cutaneous carcinosarcoma of the retro auricular region, how to treat and literature review.

INTRODUCTION: Carcinosarcomas are malignant biphasic tumours of epithelial and mesenchymal tissue. They are most often found in visceral organs, but also appear on the skin. Older age, male sex and chronic sun exposure are risk factors for its development. In this article we report a case and provide a review of literature regarding primary cutaneous carcinosarcoma (CCS) with special regard to its management. MATERIAL AND METHODS: A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30th November 2022 to identify studies that reported primary CCS. RESULTS: CCS is a rare and aggressive tumour. Diagnosis requires histological examination and immunoreactivity of epithelial and mesenchymal components to specific markers. On its diagnosis, possibility of metastasis of a visceral carcinosarcoma should always be excluded. Surgical excision with clear margins, including the use of Mohs micrographic surgery (MMS), is the primary treatment for CCS. Reconstruction the excision defect should be performed. Regular follow-up for 5 to 10 years after initial treatment is advised. CONCLUSION: Awareness for CCS is necessary in the diagnostic evaluation of skin tumours. Further research is needed to better understand the underlying mechanisms of CCS and to establish optimal management strategies for this challenging malignancy. We recommend complete surgical excision using MMS as the treatment modality for this type of skin cancer. Dermatological follow-up for at least 5 years should be conducted to monitor for recurrence.

Spindle Cell Squamous Cell Carcinoma of the Scalp Treated With Pembrolizumab Cisplatin and 5-Fluorouracil.

Cutaneous spindle cell squamous cell carcinoma (SpSCC) of the head and neck is a very rare tumor. It is an aggressive variant of squamous cell carcinoma. The usual treatment of the localized disease is surgery with or without radiotherapy. No standard treatment for metastatic disease although some case reports had reported the effectiveness of programmed cell death protein 1 (PD-1) blockade as a possible treatment. We are reporting a 57-year-old Arabic female presented with metastatic scalp spindle cell squamous carcinoma, who was treated with three lines of chemotherapy. She received pembrolizumab, cisplatin, and 5-fluorouracil for three cycles but did not respond, the pembrolizumab was dropped and we added cetuximab for three more cycles but did not respond also. She had a partial response to doxorubicin single agent as a third line. Our case showed resistance to pembrolizumab and cetuximab combined with chemotherapy regimens which are both considered as standard treatments for the classical squamous cell carcinoma of the head and neck, but there was a partial response to single-agent doxorubicin.

Basal cell carcinosarcoma of the eyelid with osteosarcomatous transformation.

A carcinosarcoma is a neoplasm with malignant epithelial and mesenchymal components. It is thought to arise by mesenchymal transformation of the epithelial elements. The cutaneous form of carcinosarcoma is rare and is associated with sun exposure; most cases arise in the head and neck. The epithelial component may be a basal cell carcinoma, a squamous cell carcinoma, or an adnexal carcinoma. The mesenchymal component may be an osteosarcoma, a pleomorphic undifferentiated sarcoma, or another type of sarcoma. Only a few cases of cutaneous carcinosarcoma have been described in the periocular skin. We present a case of basal cell carcinosarcoma with osteosarcoma and pleomorphic undifferentiated sarcoma arising in the lower eyelid of an elderly man.

Trichoblastic carcinosarcoma in a 34-year-old woman with histopathologic and molecular analysis, including re-demonstration of a CDKN2A p.(R58*) mutation.

Trichoblastic carcinosarcomas are rare, adnexal-type cutaneous carcinosarcomas that are thought to be related histogenetically to trichoblastomas, yet in which both the epithelial and stromal components show features of malignancy. Ten cases have been described in the literature thus far, with a predilection for the head and neck of older males. We present a case of cutaneous carcinosarcoma in sun-damaged skin of a 34-year-old woman showing features of a trichoblastic carcinosarcoma, with histopathologic analysis along with targeted next-generation sequencing of 50 cancer-associated genes. Two pathogenic variants in TP53 were identified, p.(R158C), p.(R273P), along with a likely pathogenic variant CDKN2A, p.(R58*). In particular, it is noted that the CDKN2A p.(R58*) missense mutation has been described in two previous cases of cutaneous carcinosarcomas, including a case of trichoblastic carcinosarcoma.

Cutaneous Carcinosarcoma: A Small Case Series and Review of the Literature of a Rare Skin Tumor.

Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this report, we describe two separate cases of carcinosarcoma presenting as nonhealing scalp wounds. Patient A: a 57-year-old male with a nonhealing skin lesion of ten years successfully treated with wide-local excision and local ortichochea flap reconstruction. Patient B: a 75-year-old female that presented with a painless, slow-growing hemorrhagic mass of 7 years invading the skull and dura ultimately requiring craniectomy and free-tissue transfer with anterolateral thigh flap. Cutaneous carcinosarcomas have more favorable outcomes due to low metastatic rates likely due to earlier detection, but delayed presentation can be fatal. Histopathological analysis is critical for determining diagnosis and prognosis. Adequate reconstruction after wide base excision varies and follows the reconstructive ladder/elevator ranging from primary closure up through free-tissue transfer. With cutaneous manifestations of carcinosarcoma seldom reported in the literature, it is our hope that reporting unusual instances such as this will raise awareness and allow for earlier diagnoses, treatments, and reconstructions.

Trichoblastic carcinosarcoma: A case report and literature review.

Trichoblastic carcinosarcoma is a rare biphasic adnexal neoplasm. This case report chronicals the eighth occurrence of this tumor published in the English literature and provides a review of the prior publications. Clinically, this tumor presents as an isolated, rapidly growing lesion in elderly patients and is usually cured by complete surgical excision, with no evidence of recurrence or metastasis at follow-up (7/8 cases). Histopathologically, trichoblastic carcinosarcoma is dermal-based, with an epithelial component of basal cells and a mesenchymal component of spindle cells, both of which display malignant features. In addition to a morphologic description of trichoblastic carcinosarcoma, a discussion of the differential diagnoses, including other biphasic neoplasms, is also included. The small number of cases of trichoblastic carcinosarcoma is most likely secondary to under-recognition and underreporting and a larger case volume is needed to more accurately assess the clinical course and treatment strategies.

Cutaneous Carcinosarcoma: a Clinicopathologic and Immunohistochemical Analysis of 11 Korean Cases.

BACKGROUND: Cutaneous carcinosarcoma is a rare biphasic tumor comprising malignant epithelial and heterologous mesenchymal elements. Data on the clinical and histopathologic characteristics of this tumor in Asian populations are not available. The purpose of this study was to investigate the clinicopathologic and immunohistochemical features of cutaneous carcinosarcoma in the Korean population. METHODS: We retrospectively reviewed the records of 11 patients with cutaneous carcinosarcoma who were diagnosed from 2006 to 2016. RESULTS: The mean patient age at diagnosis was 71.5 years (range, 43-96 years) and there was a men predilection. The most common site of cutaneous carcinosarcoma was the head and neck (8/11, 72.7%). Histopathologically, most tumors showed a characteristic morphology consisting of two types of tumor cells, varied differentiated epithelial cells (such as basal or squamous cells) and spindle cells with transition zones between the two components. These two cell types also demonstrated variable immunohistochemical characteristics. CONCLUSION: Although the number of cases in this study was limited, our results provide valuable insight into the clinical and histopathologic characteristics of cutaneous carcinosarcoma in the Korean population.

Cutaneous Carcinosarcoma: a Clinicopathologic and Immunohistochemical Analysis of 11 Korean Cases

BACKGROUND: Cutaneous carcinosarcoma is a rare biphasic tumor comprising malignant epithelial and heterologous mesenchymal elements. Data on the clinical and histopathologic characteristics of this tumor in Asian populations are not available. The purpose of this study was to investigate the clinicopathologic and immunohistochemical features of cutaneous carcinosarcoma in the Korean population. METHODS: We retrospectively reviewed the records of 11 patients with cutaneous carcinosarcoma who were diagnosed from 2006 to 2016. RESULTS: The mean patient age at diagnosis was 71.5 years (range, 43–96 years) and there was a men predilection. The most common site of cutaneous carcinosarcoma was the head and neck (8/11, 72.7%). Histopathologically, most tumors showed a characteristic morphology consisting of two types of tumor cells, varied differentiated epithelial cells (such as basal or squamous cells) and spindle cells with transition zones between the two components. These two cell types also demonstrated variable immunohistochemical characteristics. CONCLUSION: Although the number of cases in this study was limited, our results provide valuable insight into the clinical and histopathologic characteristics of cutaneous carcinosarcoma in the Korean population.

Giant Pendulous Carcinosarcoma - Squamous Cell Carcinoma-Type - of the Leg - A Case Report and Review of the Literature.

Cutaneous carcinosarcoma (CCS) is a rare non-melanoma skin cancer with a biphasic growth pattern. A tumour is composed of epithelial and mesenchymal cells that show clonality. In most cases, CCS develops in the head-and-neck region on the chronic sun-exposed skin of males. Here, we describe an 80-year-old female patient who developed a giant, pendulous CCS on the leg. A tumour was surgically removed. We found no evidence of metastatic spread.

Cutaneous carcinosarcoma: a series of six cases and a review of the literature.

BACKGROUND: Cutaneous carcinosarcoma is a rare tumor with distinct malignant epithelial and mesenchymal cell populations. The histologic subtypes of epithelial and mesenchymal components in cutaneous carcinosarcoma are variable, as an assortment of carcinomatous and sarcomatous patterns have been described in the literature. METHODS: Clinical information was obtained from patient charts and archival slides were retrieved and reviewed. RESULTS: We present a novel series of six distinct cases of cutaneous carcinosarcoma and review the literature. Our cases consisted of basal cell, pilomatrical, squamous cell, and trichoblastic variants. These cases occurred in elderly men on sun exposed skin with treatment and follow up was available for 4 of 6 cases. The four cases were treated with Mohs micrographic surgery with mean follow up of nine months. CONCLUSION: We report six cases of cutaneous carcinosarcoma with distinctive clinical and histologic characterization not previously described in a single series.

Primary Cutaneous Carcinosarcoma Composed of Squamous Cell Carcinoma and Epithelioid Sarcoma / 대한피부과학회지

Cutaneous carcinosarcoma is a biphasic, rare tumor composed of malignant epithelial and mesenchymal components. The most common carcinoma component is a squamous cell carcinoma and the most common sarcoma component is an osteosarcoma. A 74-year-old female patient presented to our hospital with a 3.5x3.5 cm-sized exophytic, eroded tumor surrounded by an erythematous plaque on her right flank that had been present for 10 years. On the incisional biopsy specimen, the tumor was composed of atypical malignant squamous cells and epithelioid cells. Furthermore, immunohistochemistry revealed that the tumor cells were positive to cytokeratin AE1/AE3, cytokeratin 5/6, epithelial membrane antigen, p63, and vimentin but were negative to HMB45, S-100, CD31, CD34, factor VIII, smooth muscle actin, and desmin. Finally, based on these histopathological and immunohistochemical findings, we diagnosed this tumor as cutaneous carcinosarcoma consisting of squamous cell carcinoma and epithelioid sarcoma.

Primary Cutaneous Carcinosarcoma of the Basal Cell Subtype Should Be Treated as a High-Risk Basal Cell Carcinoma.

BACKGROUND: Cutaneous carcinosarcoma is a rare primary tumor of the skin, characterized by biphasic epithelial and mesenchymal differentiation. OBJECTIVE: Due to the limited number of cases reported, there is no consensus regarding treatment and prognosis. Some authors suggest that cutaneous carcinosarcomas should be viewed as aggressive tumors, with ancillary imaging used to evaluate potential metastatic disease. Other reports demonstrate an indolent disease course, especially with epidermal-type cutaneous carcinosarcomas. METHODS: We report a case of cutaneous carcinosarcoma, which we treated with electrodessication and curettage following a shave biopsy. The tumor had an epithelial component resembling a basal cell carcinoma and a fibrosarcomatous stroma. RESULTS: At 1-year follow-up, our patient did not show evidence of recurrence or metastasis. CONCLUSIONS: Our case suggests that a cutaneous carcinosarcoma with an epithelial component composed of basal cell carcinoma can be regarded as a high-risk nonmelanoma skin cancer.

Primary carcinosarcoma of the skin.

Primary cutaneous carcinosarcoma is a biphasic tumour containing both malignant epithelial and malignant mesenchymal elements. The disease is a rare malignant skin tumour of unknown aetiology with significant potential to recur locally and to metastasise. Surgery is the primary therapeutic modality. We describe an unusual case of primary cutaneous Carcinosarcoma localised in the hand.

A Case of Cutaneous Carcinosarcoma / 대한피부과학회지

Carcinosarcoma is a biphasic tumor that has both epithelial as well as mesenchymal components. It most commonly occurs at the esophagus, lung, upper respiratory tract and urinary bladder, however it rarely occurs on the skin. A 62-year-old men presented with a bean sized crusted ulcer on his right cheek. A biopsy specimen revealed atypical sqamous cells mixed with spindle-shaped cells with hyperchromatic nuclei. Furthermore, immunohistochemical study showed positive reactions for AE1/AE3, cytokeratin7, epithelial membrane antigen and vimentin, but negative reactions for S100 protein, CD34 and smooth muscle actin. Based on these histopathological and immunohistochemical findings, we diagnosed this case as cutaneous carcinosarcoma. The patient was treated with complete excision and a local flap.