Pancreatic adenocarcinosarcoma of monoclonal origin:A case report

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 35; pp. 12682 - 12686
• Main Authors: Kim, Hyun Seon, Kim, Jin Il, Jeong, Minyoung, Seo, Jae Hyun, Kim, Il Kyu, Cheung, Dae Young, Kim, Tae-Jung, Kang, Chang Suk
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.09.2014
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - chemistry; Adenocarcinoma - drug therapy; Adenocarcinoma - genetics; Adenocarcinoma - secondary; Adenocarcinosarcoma; Aged; Antimetabolites, Antineoplastic - therapeutic use; Biopsy; CA-19-9 Antigen - blood; Case Report; Cell Differentiation; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; DNA; DNA Mutational Analysis; Exons; Genetic Predisposition to Disease; Humans; Immunohistochemistry; KRAS; Liver Neoplasms - blood; Liver Neoplasms - chemistry; Liver Neoplasms - drug therapy; Liver Neoplasms - genetics; Liver Neoplasms - secondary; Magnetic Resonance Imaging; Male; Metasta-sis; Neoplasms, Complex and Mixed - blood; Neoplasms, Complex and Mixed - chemistry; Neoplasms, Complex and Mixed - drug therapy; Neoplasms, Complex and Mixed - genetics; Neoplasms, Complex and Mixed - pathology; Pancreas; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - chemistry; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - pathology; Phenotype; Point Mutation; Proto-Oncogene Proteins - genetics; Proto-Oncogene Proteins p21(ras); ras Proteins - genetics; Sarcoma - blood; Sarcoma - chemistry; Sarcoma - drug therapy; Sarcoma - genetics; Sarcoma - secondary; Tomography, X-Ray Computed; Up-Regulation; Adenocarcinosarcoma; KRAS; Metastasis; Pancreas; DNA sequencing
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i35.12682

Adenocarcinosarcoma,a neoplasm containing both carcinomatous and sarcomatous components,is a rare form of a cancer and the pathophysiology is currently poorly understood.Moreover,definitive treatment guidelines for this disease have not yet been established.Pancreatic adenocarcinosarcoma is even more rare and the prognosis is fatal.Here,we report a case of a 77-year-old male with pancreatic adenocarcinosarcoma and metastasis to the liver.The patient presented at our hospital with uncontrolled glucose levels and diabetes mellitus.The patient’s laboratory findings were unremarkable with the exception of elevated carbohydrate antigen 19-9 levels.Biopsies of the tumors in the pancreas and the liver revealed two types of tumors:pancreatic adenocarcinoma and a poorly differentiated sarcoma.To determine if KRAS mutations were present,we performed a peptide nucleic acid(PNA) clamp PCR-based assay.DNA sequencing by PNA clamp PCR identified a point mutation in codon 12 of exon 2 within KRAS from both tumor types.Because the KRAS mutation is observed in both tumor components,our findings support a monoclonal tumor origin followed by subsequent divergent differentiation into the sarcomatous and carcinomatous tumor populations.After we considered the patient’s status and the late stage of tumor detection,gemcitabine chemotherapy was administered.