Adrenal gland and paraganglia
Adrenocortical carcinoma
Sarcomatoid variant

Author: Pallav Gupta, M.D. (see Authors page)

Revised: 8 August 20176, last major update September 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: sarcomatoid variant adrenal

Cite this page: Sarcomatoid variant. PathologyOutlines.com website. http://pathologyoutlines.com/topic/adrenocorticalcarcinomacarcinosarcoma.html. Accessed September 24th, 2017.
Definition / general
  • Defined as malignant neoplasms showing both epithelial and mesenchymal differentiation with heterologous features including rhabdomyoblastic, chondroid, or osteogenic differentiation
  • Within the broad category of sarcomatoid carcinoma, tumors with histological areas of both carcinoma and sarcoma containing differentiated sarcomatous elements, such as malignant cartilage, bone or skeletal muscle are subclassified as carcinosarcoma
Epidemiology
  • Ages 29 to 79 with a mean age of 53, which appears similar to conventional adrenocortical carcinoma (mean age 40-50 years old)
  • No gender preference (conventional adrenocortical carcinoma has female predominance) (Diagn Pathol 2010;5:51)
Clinical features
  • Initial clinical presentation is usually flank / abdominal pain or discomfort (Diagn Pathol 2010;5:51)
  • Two of 9 (22%) tumors were functional with production of dehydroepiandrosterone sulfate or aldosterone
  • Mean postoperative survival 5 months
Radiology description
  • Radiographically and even grossly, often difficult to confirm adrenal origin due to the advanced presentation
Case reports
Treatment
  • Surgical resection, often combined with systemic adjuvant chemotherapy
Gross description
  • Tumors tend to be very large at presentation (mean size 13.0 cm, weight 1113 grams)
  • Cut surface: heterogenous gray to pink-yellow friable
Gross images
Image hosted on other servers:

A. Tumor adherent to pancreas
B. Tumor compressing kidney

Microscopic (histologic) description
  • By definition, has an epithelioid component and a pleomorphic/spindled component
  • Epithelioid component: sheet and nests of loosely cohesive polygonal cells with clear and eosinophilic cytoplasm resembling adrenocortical cells
  • Pleomorphic/spindled component: predominantly spindle-shaped cells arranged in fascicular pattern with highly pleomorphic nuclei with dense irregularly clumped chromatin and prominent dense eosinophilic nucleoli
Microscopic (histologic) images
Images hosted on other servers:

A. Epithelioid cells with clear to eosinophilic cytoplasm in nested pattern
B. Sarcomatous component composed of uniform spindle cells in fascicular pattern
C. Sarcomatous component showing elongated or ovoid rhabdomyoblastic tumor cells
with eccentrically located nuclei and deeply eosinophilic cytoplasm

A. The carcinomatous areas are strongly synaptophysin+
B. MelanA shows patchy positivity in carcinomatous areas
C. Calretinin shows diffuse cytoplasmic and nuclear positivity in carcinomatous areas
D. Desmin highlights rhabomyoblastic cells in sarcomatous areas

Positive stains
  • Carcinomatous component: inhibin, MelanA, synaptophysin, calretinin
  • Sarcomatous component: vimentin; variable myogenin, desmin, myoglobin, caldesmon, SMA
Negative stains
  • Pancytokeratin, EMA, Hepar1, chromogranin
Molecular / cytogenetics description
  • Negative by FISH or PCR for CDK4 and MDM2 (seen in liposarcoma)
Differential diagnosis