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Int J Clin Exp Pathol 2013;6(10):2216-2223

Case Report
Primary bone carcinosarcoma of the fibula with chondrosarcoma and squamous cell
carcinoma components

Mitsuaki Ishida, Narihito Kodama, Yoshinori Takemura, Muneo Iwai, Keiko Yoshida, Akiko Kagotani, Yoshitaka Matsusue, Hidetoshi Okabe
Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Department of Orthopedic Surgery, Shiga University of
Medical Science, Shiga, Japan

Received August 6, 2013; Accepted August 29, 2013; Epub September 15, 2013; Published October 1, 2013

Abstract: Carcinosarcoma is defined as a malignant neoplasm that is composed of both carcinomatous and sarcomatous components. The
occurrence of carcinosarcoma in the bone is extremely rare. In this report, we describe the third documented de novo case of carcinosarcoma
of the bone. A 59-year-old Japanese female presented with a painful tumor in her right lower leg. Plane radiography revealed an osteolytic
destructive lesion with periosteal reaction and mineralization in the right fibula. Resection of the fibula tumor was performed under a clinical
diagnosis of chondrosarcoma. Histopathological study revealed that the tumor was comprised of three components. The main component
was proliferation of small round to short spindle cells (approximately 50%), and the remaining components were chondrosarcoma (30%) and
squamous cell carcinoma (20%). Immunohistochemically, SOX9 was expressed in the small round to spindle cells and chondrosarcoma
component, and p63 and p40 were expressed in all three components. Accordingly, an ultimate diagnosis of carcinosarcoma of the bone was
made. The clinicopathological analysis of carcinosarcoma of the bone revealed that this type of tumor affects the middle-aged to elderly
persons and occurs in the long bone. All three de novo cases had chondrosarcoma and squamous cell carcinoma components. One of the 3
patients died of the disease. The histogenesis of carcinosarcoma of the bone remains a matter of controversy, although a multpotential stem
cell theory has been proposed. Additional studies are required to clarify the clinical behavior and histogenesis of carcinosarcoma of the bone.
(IJCEP1308015).

Keywords: Carcinosarcoma, bone, chondrosarcoma, squamous cell carcinoma

Address correspondence to: Dr. Mitsuaki Ishida, Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga
University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan. Tel: +81-77-548-2603; Fax: +81-77-548-2407; E-mail:
mitsuaki@belle.shiga-med.ac.jp