A. Blair1, R. Burkhart1, J. Griffin1, J. Miller2, M. Weiss1, M. Makary1, J. Cameron1, C. Wolfgang1, J. He1 2Johns Hopkins University School Of Medicine,Department Of Pathology,Baltimore, MD, USA 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction:
Sarcomatoid carcinoma of the pancreas (SCP) is a rare histologic subtype of undifferentiated pancreatic carcinoma. Historically this has been associated with worse overall prognosis than adenocarcinoma. However, owing to the rarity of the disease, clinical course and surgical outcomes remain poorly characterized.
Methods:
A single-institution, prospectively maintained database was queried for patients who underwent pancreatic resection with a final diagnosis of SCP. We describe their histology, clinicopathologic features and perioperative outcomes. Survival data is highlighted and common traits of long-term survivors are examined.
Results:
Over a 15-year period, 7009 patents underwent pancreatic resection at our institution. Eight (0.11%) were diagnosed with SCP on final histopathology as determined by a predominance of spindle cells and sarcomatoid features with epithelial derivation. Further histologic subtyping demonstrated two cases with the presence of osteoclast like giant cells (OCGC). Mean patient age was 67 years and three patients were males (37%). Lesions were equally distributed between the head and the body/tail of the pancreas. R0 resection was achieved in six patients (75%) (Table 1). Four patients had early recurrence leading to death (<3 months). There were no deaths attributed to perioperative complications. Two (25%) experienced long term-survival (>5 years), with the longest surviving nearly 16 years despite the presence of lymph node metastasis at the time of operation. There were no long term survivors amongst those with OCGC identified on histopathology. Both long term survivors had disease in the body/tail of the pancreas and received adjuvant radiotherapy. One (50%) also received additional adjuvant gemcitabine based chemotherapy.
Conclusion:
S SCP is a rarely appreciated subset of pancreatic malignancy with bimodal outcomes. While many have rapid disease recurrence that leads to their early demise, a diagnosis of SCP does not necessarily portend to a uniformly dismal prognosis. Long-term survival is possible. Future studies are needed to better define the cohort with potential for long-term survival so that aggressive therapies may be tailored appropriately in this patient subset.
