Esophageal Carcinosarcoma Research Articles

A Case of Esophageal Carcinosarcoma Treated by Endoscopic Resection

A Case of Esophageal Carcinosarcoma Treated by Endoscopic Resection

Successful resection of esophageal carcinosarcoma in presence of right aortic arch: a case report

We herein report a giant esophageal carcinosarcoma (ECS) occupying the entire intrathoracic esophagus with a coexisting right aortic arch (RAA). The patient was admitted with severe dysphagia and weight loss. Subtotal esophagectomy was performed via left thoraco-cervical approach with cervical esophagogastric anastomosis. The aortopulmonary ligament was ligated and dissected at first for better exposure. Patient recovered uneventfully and there was no evidence of recurrence during the 1 year follow-up period. To our knowledge, this is the first report of such a giant ECS with coexisting RAA. For this kind of patient, a left thoracotomy approach and cervical anastomosis is recommended, and the dissection of aortopulmonary ligament is usually required.

Management and prognosis of esophageal carcinosarcoma

Management and prognosis of esophageal carcinosarcoma

Esophageal cancer after mediastinal irradiation for malignancies: A case-control study

Esophageal cancer after mediastinal irradiation for malignancies: A case-control study

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

Clinicopathological features of esophageal carcinosarcoma in Xinjiang

Clinicopathological features of esophageal carcinosarcoma in Xinjiang

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

Endoscopically resected giant esophageal carcinosarcoma

Endoscopically resected giant esophageal carcinosarcoma

Carcinosarcoma of esophagus—a case report and review of literature

Carcinosarcoma of esophagus contains both the carcinomatous and sarcomatous elements. These are rare polypoidal malignancies of esophagus. One such case is presented and available literature is reviewed.

Expression of receptor tyrosine kinases in esophageal carcinosarcoma

Esophageal carcinosarcoma (ECS) is a rare malignant neoplasm associated with a poor patient prognosis. It is characterized by the presence of both malignant epithelial and mesenchymal components. Molecular-targeted therapy of several receptor tyrosine kinases (RTKs) has been reported to be effective in the treatment of various malignant tumors, including carcinosarcoma of several organs. This study aimed to assess the therapeutic potential of targeting RTKs in ECS. Overexpression of RTKs was assessed in 21ECS cases by immunohistochemistry (IHC). Positively stained cases were further examined for RTK gene mutations and amplifications by direct sequencing analysis and fluorescence insitu hybridization. In epithelial components, KIT, platelet-derived growth factor receptor (PDGFR)A, PDGFRB, MET, epidermal growth factor receptor (EGFR) and HER-2 were overexpressed in 1 (4.8%), 1 (4.8%), 0 (0%), 11 (52.4%), 13 (61.9%) and 2 (9.5%) cases, respectively. In the mesenchymal components the corresponding numbers of cases were 2 (9.5%), 2 (9.5%), 0 (0%), 12 (57.1%), 11 (52.4%) and 0 (0%). No mutations in the c-kit, PDGFRA and c-met genes were found. Among 19EGFR-positive tumors, 2 had EGFR missense mutations (T790A, exon 20) only in the mesenchymal component. Gene amplification or high polysomy of c-kit, PDGFRA, c-met and EGFR was observed in 1 (33.3%), 0 (0%), 3 (18.8%) and 10 (52.6%) cases, respectively. In conclusion, various RTKs, particularly MET and EGFR were overexpressed in ECSs suggesting that molecular-targeted therapies directed to MET, EGFR or other RTKs may be effective in inhibiting the growth or progression of the epithelial and/or mesenchymal component of ECS.

喉頭温存が可能であった巨大頸部胸部上部食道癌肉腫の１例

喉頭温存が可能であった巨大頸部胸部上部食道癌肉腫の１例

Esophageal Carcinosarcoma: A Unique Entity with Better Prognosis

Esophageal carcinosarcoma is a rare kind of malignancy, and how to identify the patients with poor prognosis is critical for improving treatment efficacy and survival outcome. The clinical characteristics, pathologic features, treatments, and outcomes of esophageal carcinosarcoma were analyzed in 33 patients. Meanwhile, we hypothesized that elevated neutrophil to lymphocyte ratio (NLR) correlates with poor prognosis. Most patients had polypoid tumors, and the carcinomatous elements were squamous in all patients except one with adenosquamous carcinoma. Eight patients had elevated NLR (≥5). The median follow-up time was 39.1 (range, 0.5-178.2) months. The median overall survival time (OS) was 43.5 months, and the 1-, 3-, and 5-year OS rates were 74, 57, and 48%, respectively. Tumor recurrence occurred in 15 patients, and the median relapse-free survival time (RFS) was 23.9 months, and the 2-year RFS rate was 50%. For patients who received curative resection, OS and RFS were significantly associated with preoperative NLR. In the multivariate Cox regression model, higher NLR was an independent prognostic factor (P value was 0.001 for both OS and RFS). Our study identified the baseline NLR to be an independently prognostic factor for curatively resected esophageal carcinosarcoma.

Clinical manifestation and prognosis of the surgical treatment of esophageal carcinosarcoma

To investigate the clinical characteristics and prognostic factors of esophageal carcinosarcoma. The clinical data of patients treated by surgery and pathologically diagnosed as esophageal carcinosarcoma between January 1967 and December 2008 were retrospectively reviewed. There were 28 male and 4 female patients aged from 39 to 76 years with a median age of 58 years. All the data were analyzed using SPSS 15.0 software. The overall survival rates were calculated and compared with the Kaplan-Meier method and the Log-rank test. The prognostic factors were identified by Cox hazard regression model. Among all the 32 patients included, 29 patients were polypoid type, 2 patients were fungoid type and 1 patient were medullary type. With regard to the depth of tumor infiltration, 17 patients involved the mucosa or submucosa (pT1), 13 patients involved the muscularis propria (pT2), 2 patients involved the adventitia (pT3). The involvement of local lymph nodes was present in 10 patients, with an incidence of 31.3%, including metastatic carcinoma alone in 7 patients and both carcinomatous and sarcomatous components in 3 patients. According to the most recently published international TNM staging system for esophageal carcinoma (AJCC 2009), 15 patients were in stage I, 13 patients in stage II, 4 patients in stage III. The 1-, 3- and 5-year overall survival rates of the whole group were 90.0%, 72.1% and 57.0%, respectively. Both in single-factor prognostic analysis and in Cox multivariate analysis, pathological N stage was the only prognostic factor (RR = 2.531, 95%CI: 1.055 - 6.070). Esophageal carcinosarcoma is consisted of both sarcomatous component and carcinomatous component, while the latter one appears more frequently in local lymph node metastasis. In multivariate prognostic analysis, pathological N stage is the only independent prognostic factor. Curative resection of this tumor may achieve good prognosis because of its' lower incidence of lymph node metastasis and less invasive tendency.

小細胞癌成分を含む食道癌肉腫の１切除例

We experienced a case of esophageal carcinosarcoma with a component of small cell carcinoma. The patient was a 73-year-old man. We administered chemotherapy of CDDP+VP-16, and performed an operation after 2 courses of this chemotherapy. Subtotal esophagectomy and reconstruction with the small intestine was performed. More than three years after resection, he remains alive and recurrence-free. There are few cases of esophageal carcinosarcoma and small cell carcinoma. We report this rare case herein.

A case of huge esophageal carcinosarcoma

Carcinosarcoma of the esophagus is a rare malignant neoplasm with both epithelial and mesenchymal (sarcomatous) components. We describe a case of a 72-year-old man with a huge esophageal tumor which could often have been considered inoperable. However, the patient underwent a curative resection and had a good prognosis. In this report, we suggest that carcinosarcomas have a lower tendency of invasion, even late in their course. We therefore recommend aggressive surgical resection of this kind of tumor.

An Unusual Case of Intraluminally Growing Esophageal Tumor

Question: A 78-year-old man presented with a 2-month history of progressive dysphagia to solids. His past medical history revealed heavy tobacco use and chronic obstructive pulmonary disease. He denied any recent history of weight loss or a history of food impaction. On presentation, there were no palpable lymph nodes or liver enlargement. Laboratory data were not pertinent except for slight elevation of SCC to 3.6 ng/mL. A barium esophagogram revealed a 5-cm filling defect in the esophagus 20 cm distal to the incisors. Upper GI endoscopy demonstrated a large, elastic, circumferential mass almost entirely occupying the lumen in the upper esophagus, but the endoscope easily passed the lesion (Figure A). What is your diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pathologic findings obtained from biopsy specimens revealed spindle-shaped cells as well as moderately differentiated squamous cell carcinomas in the same view, and there was a transitional zone (Figure B, arrow) between the sarcomatous (above the arrow) and the carcinomatous components (below the arrow). Computed tomography showed regional lymph node metastasis, but no distant metastasis. Immunohistochemical staining for cytokeratin AE1/AE3 antibodies were positive in the spindle-shaped cells (Figure C), which confirmed the diagnosis of carcinosarcoma of the esophagus (cT3N1M0, stage III). This patient was not a candidate for esophagectomy because of his age and advanced lung disease, so he was treated with chemoradiation with remarkable response (Figure D).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Carcinosarcoma of the esophagus is an uncommon malignancy of the esophagus with both carcinomatous and sarcomatous components, and it represents only 1%–2% of all esophageal neoplasms. There were 2 major proposed explanations for the pathogenesis of carcinosarcomas: The metaplastic and the collision concepts. The metaplastic concept is that individual elements might be derived from a single common ancestor cell (so-called carcinosarcoma), whereas the collision concept is that 2 individual stem cells may independently and simultaneously undergo malignant transformation (true carcinosarcoma).1Iwaya T. Maesawa C. Uesugi N. et al.True carcinosarcoma of the esophagus.Dis Esophagus. 2006; 19: 48-52Crossref PubMed Scopus (17) Google Scholar Recent studies have supported the metaplastic concept of carcinosarcoma. Therefore, most esophageal carcinosarcomas are diagnosed as a so-called carcinosarcoma. This tumor often presents as a bulky intraluminal polypoid lesion, and thus often causes symptoms of dysphagia.2Madan A.K. Long A.E. Weldon C.B. et al.Esophageal carcinosarcoma.J Gastrointest Surg. 2001; 5: 414-417Crossref PubMed Scopus (48) Google Scholar Esophageal carcinosarcomas are usually treated according to same protocol as other esophageal cancers. This case highlights that esophageal carcinosarcoma should be considered in the differential diagnosis of esophageal tumors growing intraluminally.

Esophageal Carcinosarcoma Presenting as a Fever With Elevated Serum Interleukin-6

We report a patient with esophageal carcinosarcoma who initially presented with fever. A 57-year-old man with a 4-month history of intermittent fever was referred to our hospital and diagnosed as having esophageal carcinosarcoma. High fever persisted and serum concentration of interleukin-6 was markedly elevated. In contrast, after thoracic esophagectomy, the fever subsided and interleukin-6 serum levels rapidly normalized. The clinical course of the patient suggests that the tumor produced interleukin-6 and this was associated not only with inflammation, but also the aggressive biologic behavior of the tumor.

Synchronous Primary Carcinosarcoma and Adenosquamous Carcinoma of the Esophagus

Reports of adenosquamous carcinoma and carcinosarcoma found at the same esophagus are rare in the literature. We report a case of synchronous adenocarcinoma and carcinosarcoma of the esophagus. The sarcomatous components were immunoreactive for vimentin. Carcinoma, sarcoma, and adenocarcinoma cells distinctively metastasized to different lymph nodes. Further investigations are required to reveal the biological behavior of the tumor.

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.