Esophageal carcinosarcoma (ECS) is a rare malignant tumor that often presents as an intraluminal polypoid lesion in the esophageal lumen. The pathogenesis of esophageal carcinosarcoma is not clear and its etiology is still being discussed.

We report the case of a 68-year-old male who had dysphagia for approximately three months. Contrast-enhanced computed tomography showed an irregular enhancing mass in the lower esophagus. Endoscopy showed a gray-white mass with a smooth surface that almost filled the esophageal lumen at a location 28 cm from the incisor tooth. Considering the location of the tumor, we opted for Ivor-Lewis esophagectomy with intrathoracic anastomosis through a 5-port laparoscope and uniport video-assisted thoracic surgery (VATS). Pathological analysis showed that the mass comprised carcinoma in situ and pleomorphic sarcoma, without lymphatic metastasis. The postoperative pathological stage was T1bN0M0, stage I (Japanese Classification of Esophageal Cancer 11th Edition). The latest follow-up of the patient was 14 months after the surgery, and no signs of recurrence or metastasis were found.

This case demonstrates a rare esophageal malignancy with a peculiar histological composition. Successful VATS esophagectomy with intrathoracic anastomosis was conducted without recurrence or metastasis at the 14-month follow-up.

• Carcinosarcoma
• Case report
• Esophagus
• Video assisted thoracic surgery (VATS)

Granulocyte colony-stimulating factor (G-CSF)-producing tumors have an aggressive clinical course. Here, we report five cases of G-CSF-producing tumors and review the literature, focusing on imaging findings related to tumor-produced G-CSF. In addition to our cases, we identified 30 previous reports of G-CSF-producing tumors on which ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT, bone scintigraphy, or evaluation of bone marrow MR findings was performed. White blood cell count, serum C-reactive protein, and serum interleukin-6 were elevated in all cases for which these parameters were measured. G-CSF-producing tumors presented large necrotic masses (mean diameter 83.2 mm, range 17–195 mm) with marked FDG uptake (mean maximum standardized uptake value: 20.09). Diffuse FDG uptake into the bone marrow was shown in 28 of the 31 cases in which FDG-PET/CT was performed. The signal intensity of bone marrow suggested marrow reconversion in all seven MRI-assessable cases. Bone scintigraphy demonstrated no significant uptake, except in two cases with bone metastases. Splenic FDG uptake was increased in 8 of 10 cases in which it was evaluated. These imaging findings may reflect the effects of tumor-produced G-CSF. The presence of G-CSF-producing tumors should be considered in patients with cancer who show these imaging findings and marked inflammatory features of unknown origin.

• Granulocyte colony-stimulating factor-producing tumors
• Imaging findings
• Literature review
• Magnetic resonance imaging
• Positron emission tomography

• Colorectal cancer
• G-CSF
• G-CSF receptor
• Immune cells
• Tumor microenvironment

• dietary fiber
• esophagus
• nutrition
• polyphenols
• refined grains
• stomach and colorectal cancer
• whole grains

• Colorectal Neoplasms
• Dietary Fiber/therapeutic use
• Eating
• Edible Grain
• Esophageal Neoplasms
• Gastrointestinal Neoplasms
• Gastrointestinal Tract
• Health Promotion
• Humans
• Polyphenols/therapeutic use
• Stomach
• Whole Grains

Carcinosarcoma (spindle cell carcinoma) of the esophagus is an extremely rare event; the etiology and origins of this neoplasm have not yet been determined. Epithelial-mesenchymal transition (EMT) has been associated with invasion and metastasis, and may be related to the generation of a stem cell population within this tumor.

We present the case of a 61-year-old male with nausea and fever. Upper gastrointestinal endoscopy revealed the presence of type 1 and 0-IIc lesions located 35 cm from the incisors toward the esophago-gastric junction. Thoracoscopic esophagectomy was performed. Macroscopic analysis revealed three polypoid lesions in the abdominal esophagus that accompanied the main lesion in the lower thoracic esophagus and 0-IIc lesions that spread continuously with them. Histologically, the lesions included proliferating spindle cells. Adeno-carcinomatous components were detected in a section near the foot, and squamous cell carcinoma was identified in the mucosa at the base of the tumor. The patient was diagnosed with multiple carcinosarcomas, staged at pT1b (SM3), pN1 (#110, #7), cM0, Stage II (sarcomatous metastasis to the lymph nodes). Spindle cells did not express E-cadherin but were positive for EMT markers, including zinc finger E-box-binding homeobox 1, TWIST, and snail family transcriptional repressor 2. The patient has experienced no recurrence at 5 years and 2 mo after surgery.

This report suggests that multiple sarcomatous tumors may be generated from primary squamous cell carcinoma via mechanisms related to EMT.

• Esophagus
• Multiple carcinosarcomas
• Multiple spindle cell carcinomas
• Epithelial-mesenchymal transition
• Epithelial-mesenchymal transition markers
• Case report

• Adenocarcinoma/diagnosis
• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Biomarkers, Tumor/analysis
• Biomarkers, Tumor/metabolism
• Carcinosarcoma/diagnosis
• Carcinosarcoma/pathology
• Carcinosarcoma/surgery
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophagectomy/methods
• Esophagus/diagnostic imaging
• Esophagus/pathology
• Esophagus/surgery
• Humans
• Male
• Middle Aged
• Neoplasms, Complex and Mixed/diagnosis
• Neoplasms, Complex and Mixed/pathology
• Neoplasms, Complex and Mixed/surgery
• Neoplasms, Multiple Primary/diagnosis
• Neoplasms, Multiple Primary/pathology
• Neoplasms, Multiple Primary/surgery
• Thoracoscopy
• Treatment Outcome

• epithelial-mesenchymal transition (EMT)
• granulocyte colony-stimulating factor (G-CSF)-producing
• interleukin-6 (IL-6)-producing
• large-cell carcinoma (LCC) of the lung
• sarcomatoid component

• Aged
• Autopsy
• Carcinoma, Large Cell/pathology
• Epithelial-Mesenchymal Transition/physiology
• Granulocyte Colony-Stimulating Factor/metabolism
• Humans
• Interleukin-6/metabolism
• Lung Neoplasms/pathology
• Male
• Sarcoma/pathology

Esophagus cancer is the seventh cause of cancer-related deaths globally. In this study, we analyzed interleukin 6 (IL-6) gene expression in human esophagus cancer patients and showed that IL-6 mRNA levels are significantly higher in tumor tissues and negatively correlated with overall survival, suggesting that IL-6 is a potential therapeutic target for esophagus cancer. We further demonstrated that apigenin, a nature flavone product of green plants, inhibited IL-6 transcription and gene expression in human esophagus cancer Eca-109 and Kyse-30 cells. Apigenin significantly and dose-dependently inhibited cell proliferation and promoted apoptosis while stimulating the cleaved PARP (poly ADP-ribose polymerase) (C-PARP) and caspase-8 expression. It suppressed VEGF (Vascular endothelial growth Factor) expression and tumor-induced angiogenesis. Pretreatment of cells with IL-6 could completely reverse apigenin-induced cellular changes. Finally, using a preclinical nude mice model subcutaneously xenografted with Eca-109 cells, we demonstrated the in vivo antitumor activity and mechanisms of apigenin. Taken together, this study revealed for the first time that apigenin is a new IL-6 transcription inhibitor and that inhibiting IL-6 transcription is one of the mechanisms by which apigenin exhibits its anticancer effects. The potential clinical applications of apigenin in treating esophagus cancer warrant further investigations.

• P30 ES005605 NIEHS NIH HHS