Case Of Esophageal Carcinosarcoma Research Articles

Carcinosarcoma of the esophagus: A report of 6 cases associated with zinc finger E-box-binding homeobox 1 expression.

Esophageal carcinosarcoma (ECS) has been suggested to result from an epithelial mesenchymal transition (EMT) phenomenon. However, knowledge on its underlying molecular features is limited. The clinical and pathological features, and the prognosis of ECS require further investigation. In the present study, a total of 325 patients with esophageal tumors were observed between January 2004 and December 2014, of which 6 patients were diagnosed pathologically with ECS. The clinicopathological features were compared with those of corresponding cases with the identical pathological T stage (pT) of esophageal squamous cell carcinoma (ESCC). In terms of the clinical T stage (cT), the 6 cases were composed of cT1, cT2, cT3 and cT4 in 1, 1, 3 and 1 case, respectively. Nevertheless, pT was eventually diagnosed as pT1 in all cases. There was a large discrepancy between clinically diagnosed depth of tumor invasion prior to surgery and depth of tumor invasion following surgery. Zinc finger E-box-binding homeobox 1 (ZEB1), an EMT-associated transcription factor, was expressed only in the sarcoma component in all 6 cases of ECS. The ECS cases had a significantly poorer prognosis compared with the 115 pT1 ESCC cases. The present study suggests that the depth of invasion of ECS lesions does not correspond with their respective size, and the EMT of the carcinoma component may affect the prognosis by overexpression of the ZEB1 gene.

Next-generation sequencing of esophageal carcinosarcoma to reveal high frequency of actionable PIK3CA gene mutations.

e15503 Background: Esophageal carcinosarcoma (ESC) is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous components. Drive genes mutations may potentially serve as novel biomarkers to targeted therapy in ESC, and they also may explain the mechanisms of the unique dual-differentiation pattern. Actionable gene alterations with any significant frequency in ESC were unknown due to specimen numbers and limited studies. A comprehensive study of clinical characteristic and molecular alterations in ESC is needed to better understand biology and guide therapy. Methods: Fifteen cases of ESCs which received surgical resection were retrospectively collected from the Zhejiang Cancer Hospital in China between 2009 and 2016, next generation sequencing was performed to identify genotypic changes, and clinical characteristic of these patients was also collected and analyzed. Results: ESC patients are easily occurred in male, heavy smokers, and old patients. The mainly gross types were medullary and fungating type. Mutation of phosphatase and tensin homologue ( PTEN), MAP2K1(MEK1), anaplastic lymphoma kinase ( ALK), RET, and NF1 were detected in one patient respectively. Mutation of ERBB2(HER2), MET and single copy loss of Rb1 were detected in two patients respectively. Mutation of ROS1 and phosphoinositide-3-kinase catalytic alpha ( PIK3CA) were detected in three patients respectively. Conclusions:PIK/AKT pathway may be important in pathogenesis of ESCs, and it may be an ideal therapeutic target.

Clinical analysis of 24 cases of esophageal carcinosarcoma

食管癌肉瘤是一种罕见的食管恶性肿瘤,我科在1998年8月至2013年8月期间手术治疗食管癌5 619例,经手术及病理证实食管癌肉瘤24例,发生率为0.43％,现报告如下.一、资料与方法1.临床资料:全组24例患者中,男19例,女5例;年龄47～71岁,平均年龄61.4岁.主要症状为进行性吞咽困难1～8个月,平均2.2个月.上消化道钡餐检查显示,肿瘤位于中段食管19例,上段食管4例,下段食管1例.24例胃镜下可见腔内息肉样新生物,术前镜下活检病理为肉瘤5例,鳞癌19例. 关键词：食管肿瘤;癌肉瘤;外科手术;预后

食道癌肉腫7症例の臨床病理学的検討

食道癌肉腫7症例の臨床病理学的検討

A Case of Esophageal Carcinosarcoma, which Proliferated after Radical Radiochemotherapy for Superficial Esophageal Carcinoma

症例は74歳の男性で，1998年，食道癌T1bN0M0，stage Iに対して根治的化学放射線療法を施行し，Complete Responseを得た．2004年，同部位に結節性病変を認め，狭窄を危ぐし，内視鏡的切除を行った．2008年，再度隆起性病変を認め，生検では異型上皮だったが，その肛門側に不染領域を認め，扁平上皮癌と診断された．不染領域は隆起と連続し，粘膜下進展を考慮し，右開胸開腹食道胃上部切除，2領域リンパ節郭清，消化管再建を施行した．病理組織学的検査ではcarcinosarcomaであり，扁平上皮癌とともに，異型紡錐状細胞の密な増生を認めた．術後1年経過し，再発を認めていない．化学放射線療法後の食道癌肉腫の発生は本邦では1例のみ報告されているが，本症例は初回治療から長期間を経て発生しており，その発生機序，病理組織学的検査所見について若干の文献的考察を加えて報告する．

Carcinosarcoma of the esophagus treated with chemoradiotherapy: report of four cases

Esophageal carcinosarcoma is a rare neoplasm. Esophagectomy with lymph node dissection has often been performed, although the efficacy of chemotherapy or radiotherapy is not yet confirmed. Four cases of esophageal carcinosarcoma who underwent chemoradiotherapy are presented. Complete response of the primary tumor was observed in one case; tumor size decreased in three cases. Two patients have been observed to be disease free, another patient died of metastatic disease, and the other had recurrence. Six cases of carcinosarcoma treated with chemoradiotherapy were retrieved from the literature and analyzed with the four cases in the current study. Reduction of the tumor was observed in seven of the ten cases. Disease progression or local recurrence was observed in three cases, and another two cases died of metastatic disease. Although chemoradiotherapy seems to be capable of local control, whether it is beneficial in terms of prolonging survival of patients with this disease remains unknown.

Esophageal carcinosarcoma with intramural metastasis

A case of esophageal carcinosarcoma is described herein. A 58-year-old man presented with dysphagia and was admitted to our hospital. Imaging studies revealed a type 3 tumor in the upper intrathoracic esophagus with direct invasion to the left main bronchus. Analysis of a biopsy specimen revealed carcinosarcoma. The patient underwent esophageal bypass and chemoradiotherapy. Eight months after surgery, he died of esophago-bronchial fistula. Autopsy examination revealed liver metastasis, peritoneal dissemination and intramural metastasis. The sarcomatous component was predominant in the intramural and liver metastatic lesions.

MDM2 and CDK4 Expression in Carcinosarcoma of the Esophagus: Comparison with Squamous Cell Carcinoma and Review of the Literature

Certain tumors of the esophagus that display both sarcomatous and carcinomatous features have long been recognized. The nomenclature, classification, and histogenesis remain controversial and the microscopic differential diagnosis from other esophageal malignancies can be challenging, particularly in small biopsies. In this paper, we review the literature of carcinosarcoma and present two cases of esophageal carcinosarcoma, describing their salient histologic, immunohistochemical, and ultrastructural features. Also, we assess the expression of MDM2 and CDK4 in the carcinomatous and sarcomatous compartments of our cases and we compare them with the expression of these oncogenes in selected cases of esophageal squamous cell carcinoma with prominent stromal reaction. In both of our cases, identification of some epithelial ultrastructural and immunohistochemical features in cells of otherwise sarcomatous phenotype lends support to the common epithelial origin of these neoplasms. Moreover, positive staining for MDM2 and CDK4 in our cases with equally strong reactions in both carcinomatous and sarcomatous elements provides evidence of a role for these molecules in the pathogenesis of carcinosarcoma. In contrast, in cases of squamous cell carcinoma with prominent stromal reaction only the epithelial cells stained strongly for MDM2 and CDK4. These differences in the MDM2 and CDK4 immunohistochemical profile between carcinosarcomas and carcinomas of the esophagus may assist in their differential diagnosis.