# Sarcomatoid carcinoma of the common bile duct: A case report and review of the literature

## TL;DR

This case report describes a rare type of bile duct cancer called sarcomatoid carcinoma and highlights the diagnostic and treatment challenges associated with it.

## Contribution

The paper presents a new case of sarcomatoid carcinoma of the common bile duct and reviews the limited existing literature on this rare malignancy.

## Key findings

- The patient was diagnosed with sarcomatoid carcinoma after histopathology and immunohistochemical staining confirmed epithelial markers.
- The patient underwent pancreaticoduodenectomy and remained recurrence-free for 16 months without adjuvant chemotherapy.
- The paper emphasizes the importance of tissue confirmation and immunohistochemical analysis for accurate diagnosis.

## Abstract

Sarcomatoid carcinoma of the common bile duct is an exceptionally rare malignancy, with only eight cases previously reported in the English literature. We present the case of a 72-year-old Caucasian male who presented with obstructive jaundice and abnormal liver function tests, but without elevated tumour markers CA19-9 and CEA. Imaging with CT and MRCP revealed a polypoid mass in the common bile duct, and two ERCP attempts were unsuccessful. The patient underwent a pancreaticoduodenectomy without adjuvant chemotherapy and has remained recurrence-free for 16 months. Histopathology revealed sarcomatoid spindle cells negative for the expression of sarcomatous markers but positive for epithelial markers CAM5.2 and AE1/3, as well as MNF focally, along with chronic cholecystitis. Sarcomatoid carcinoma is a rare and challenging diagnosis that requires tissue confirmation and immunohistochemical staining for accurate identification. Despite its rarity, it is important to consider sarcomatoid carcinoma in the differential diagnosis of polypoid masses of the common bile duct, especially in the absence of elevated tumour markers. There is inconclusive evidence regarding the clinical outcomes for sarcomatoid carcinoma of the common bile duct and the effectiveness of various treatment strategies. Current literature indicates the widespread use of pancreaticoduodenectomy; while the role of chemotherapy remains unclear.

The online version contains supplementary material available at 10.1007/s13691-026-00852-8.