Abstract：
BACKGROUND: Gastric carcinosarcoma is most frequently diagnosed at an advanced stage when the tumor is generally large with invasion into other organs, lymph node metastasis, and distant metastasis. Standard chemotherapy has not been established, and surgery is the only curative treatment. Here, we present a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib.
METHODS: A 77-year-old man was referred to our hospital because of nausea and vomiting. Computed tomography and upper gastrointestinal endoscopy revealed a type 1 tumor arising from the gastric antrum and extending into the duodenal bulb. He underwent distal gastrectomy (D2) with Roux-en-Y reconstruction. Histopathologically, the tumor had mixed adenocarcinoma and sarcoma components. According to the tumor-node-metastasis classification, the diagnosis was primary gastric carcinosarcoma pT1bN1M0 stage IB. Liver metastasis was detected 2 months after surgery; multiple lung metastases were detected 17 month after surgery. A genomic profiling test was performed using liver specimens as the patient became refractory to chemotherapy commonly used for gastric cancer, and the test revealed FGFR2 amplification along with TP53 R209*, AKT3 N127D, NOTCH1 A2036T, and POLD1 M161I. The patient was treated with pazopanib (800 mg/daily), and the tumor growth was controlled for 11 months.
CONCLUSIONS: We report a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib. This case suggested that pazopanib may be effective in treating gastric carcinosarcoma.
METHODS: A 77-year-old man was referred to our hospital because of nausea and vomiting. Computed tomography and upper gastrointestinal endoscopy revealed a type 1 tumor arising from the gastric antrum and extending into the duodenal bulb. He underwent distal gastrectomy (D2) with Roux-en-Y reconstruction. Histopathologically, the tumor had mixed adenocarcinoma and sarcoma components. According to the tumor-node-metastasis classification, the diagnosis was primary gastric carcinosarcoma pT1bN1M0 stage IB. Liver metastasis was detected 2 months after surgery; multiple lung metastases were detected 17 month after surgery. A genomic profiling test was performed using liver specimens as the patient became refractory to chemotherapy commonly used for gastric cancer, and the test revealed FGFR2 amplification along with TP53 R209*, AKT3 N127D, NOTCH1 A2036T, and POLD1 M161I. The patient was treated with pazopanib (800 mg/daily), and the tumor growth was controlled for 11 months.
CONCLUSIONS: We report a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib. This case suggested that pazopanib may be effective in treating gastric carcinosarcoma.
摘要：
背景：胃癌肉瘤最常被诊断为晚期，此时肿瘤通常较大并侵犯其他器官，淋巴结转移,和远处转移。标准化疗尚未建立，手术是唯一的治疗方法。这里,我们介绍了一例在帕唑帕尼长期控制下胃癌肉瘤术后复发的病例。
方法：一名77岁男子因恶心呕吐被转诊至我院。计算机断层扫描和上消化道内窥镜检查显示1型肿瘤起源于胃窦并延伸到十二指肠球。他接受了远端胃切除术（D2）和Roux-en-Y重建。组织病理学,肿瘤有混合的腺癌和肉瘤成分。根据肿瘤淋巴结转移分类，诊断为原发性胃癌肉瘤pT1bN1M0IB期。术后2个月发现肝转移；术后17个月发现多发肺转移。当患者对常用于胃癌的化疗变得难治时，使用肝脏标本进行了基因组谱分析测试，测试显示FGFR2扩增以及TP53R209*，AKT3N127D,NOTCH1A2036T,和POLD1M161I。患者接受帕唑帕尼治疗（800毫克/天），肿瘤生长控制了11个月。
结论：我们报告了一例在长期肿瘤控制下使用帕唑帕尼的胃癌肉瘤术后复发的病例。该病例表明帕唑帕尼可能对胃癌肉瘤有效。
方法：一名77岁男子因恶心呕吐被转诊至我院。计算机断层扫描和上消化道内窥镜检查显示1型肿瘤起源于胃窦并延伸到十二指肠球。他接受了远端胃切除术（D2）和Roux-en-Y重建。组织病理学,肿瘤有混合的腺癌和肉瘤成分。根据肿瘤淋巴结转移分类，诊断为原发性胃癌肉瘤pT1bN1M0IB期。术后2个月发现肝转移；术后17个月发现多发肺转移。当患者对常用于胃癌的化疗变得难治时，使用肝脏标本进行了基因组谱分析测试，测试显示FGFR2扩增以及TP53R209*，AKT3N127D,NOTCH1A2036T,和POLD1M161I。患者接受帕唑帕尼治疗（800毫克/天），肿瘤生长控制了11个月。
结论：我们报告了一例在长期肿瘤控制下使用帕唑帕尼的胃癌肉瘤术后复发的病例。该病例表明帕唑帕尼可能对胃癌肉瘤有效。
