Abstract
An 80-year-old man with mild anemia was found to have multiple protruding tumors in the upper and middle gastric body on upper gastrointestinal endoscopy. The biopsy specimen revealed adenocarcinoma. He underwent total gastrectomy and splenectomy with a Roux-en-Y reconstruction. Macroscopic findings of the resected specimen included four polypoid tumors in the gastric body. On pathology of the upper gastric tumor, a carcinosarcoma with an intimately mixed adenocarcinoma and a spindle-shaped sarcomatous component was diagnosed. The middle gastric tumors were intramural metastases composed of sarcomatous elements with spindle-shaped cells. A microscopic lymph node metastasis with adenocarcinoma cells was seen in the right paracardial lymph node. Postoperatively, the patient developed a superior mesenteric artery occlusion. In spite of an emergency operation and intensive care, he died on the 64th postoperative day. Based on the results of the autopsy, gastric carcinosarcoma with intimal metastasis in the aorta and sarcomatous elements with spindle cells in the intima of the descending aorta were diagnosed. This is the first case report of a gastric carcinosarcoma with intramural metastases composed of a single sarcomatous component. Furthermore, the sarcomatous elements of gastric carcinosarcoma had spread to the intima of the aorta.
