A Case of Spindle Cell Carcinoma of the Stomach Presenting with Hematochezia and Weight Loss Due to Fistulous Tract Formation with Colon

Ji Won An; Dae Young Cheung; Min Woo Seo; Hyun Jung Lee; In Kyu Lee; Tae Jung Kim; Jin Il Kim; Jae Kwang Kim

doi:10.4166/kjg.2013.62.2.126

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An, Cheung, Seo, Lee, Lee, Kim, Kim, and Kim: A Case of Spindle Cell Carcinoma of the Stomach Presenting with Hematochezia and Weight Loss Due to Fistulous Tract Formation with Colon

Case Report

Korean J Gastroenterol 2013;62(2):126-130.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.2.126

A Case of Spindle Cell Carcinoma of the Stomach Presenting with Hematochezia and Weight Loss Due to Fistulous Tract Formation with Colon

Ji Won An, Dae Young Cheung, Min Woo Seo, Hyun Jung Lee, In Kyu Lee¹, Tae Jung Kim², Jin Il Kim, Jae Kwang Kim

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

¹Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea

²Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea

Correspondence to: Dae Young Cheung, Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, 10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: +82-2-3779-2382, Fax: +82-2-3779-1331, E-mail: adagio@catholic.ac.kr

Received 31 August 2012 Revised 24 January 2013 Accepted 2 February 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Spindle cell carcinoma (SpCC) is a rare tumor consisting of spindle cells which express cytokeratin. Despite recent advances in immunohistochemical and genetic studies, precise histogenesis of SpCC is still controversial and this tumor had been referred to with a wide range of names (in the past): carcinosarcoma, pseudosarcoma, sarcomatoid carcinoma, pseudosarcomatous carcinoma, and collision tumor. Recently, the authors experienced an extremely rare case of SpCC arising from the stomach. A 64-year-old male presented with unintended weight loss and hematochezia. Endoscopic examination revealed a fistulous tract between the stomach and the transverse colon which was made by direct invasion of SpCC of the stomach to the colon. Histologically, the tumor was positive for both vimentin and cytokeratin but negative for CD117, CD34, actin, and desmin. Herein, we report a case of SpCC arising from the stomach that formed a fistulous tract with the colon which was diagnosed during evaluation of hematochezia and weight loss.

Keywords: Stomach, Spindle-cell carcinoma, Gastric fistula

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Fig. 1.

Endoscopic findings of spindle cell carcinoma. (A) Esophagogastroduodenoscopy shows a large ulceroinfiltrative lesion with fistulous opening on the greater curvature side of the gastric body. (B) Colonoscopy also shows ulceroinfiltrative lesion on the mid transverse colon.

Fig. 2.

Histological findings of spindle cell carcinoma. (A) Diffuse proliferation of spindle-shaped cells with infiltration of neutrophils is seen (H&E,×40). (B) Atypical spindle-shaped cells with nuclear enlargement and polymorphism are observed (H&E, ×400). Both vimentin (C) and cytokeratin (D) are positively stained on the same section (immunohistochemical stain, ×100).

Fig. 3.

Abdominal CT scan shows irregular wall thickening of the greater curvature side of gastric body with transverse colon invasion.

Fig. 4.

Upper gastrointestinal series shows fistula between the gastric body and transverse colon without peritoneal leakage.

Fig. 5.

Macroscopic features of the specimen. Gastric wall is thickened due to infiltration by spindle cell carcinoma (white arrowheads). The mass invades directly to adjacent fat tissue and transverse colon (black arrowheads). The central portion of the mass underwent necrotic change and forms a fistulous tract between the stomach and colon.

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