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Madhawa JKG, Wijesinghe H, Rajapaksha RAMN, Saranga V, Wickramasinghe VC. Sarcomatoid Carcinoma of the Ileum Mimicking a Gastrointestinal Stromal Tumor (GIST) Presenting With Primary Subfertility: A Report of a Rare Case. Cureus 2025; 17:e80716. [PMID: 40242691 PMCID: PMC12002094 DOI: 10.7759/cureus.80716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2025] [Indexed: 04/18/2025] Open
Abstract
Sarcomatoid carcinoma (SCA) is a rare and aggressive malignancy characterized by the coexistence of epithelial and mesenchymal components. While it has been described in various organs, SCA of the ileum is exceptionally rare, with only handful of cases reported in the literature to date. We report a case of a 38-year-old woman presenting with primary subfertility and episodic lower abdominal pain, initially attributed to possible adenomyosis. During subfertility evaluation with a laparoscopic dye test, an incidental polypoidal growth was detected in the distal ileum. Contrast-enhanced computed tomography (CECT) revealed a heterogeneously enhancing mass in the right iliac fossa, suspected to be a gastrointestinal stromal tumor (GIST). Following multidisciplinary team discussions, surgical excision was performed with a laparoscopic assisted right hemicolectomy. Histopathological analysis confirmed a biphasic tumor with carcinomatous and sarcomatous components, consistent with SCA. Evaluation with immunohistochemical markers further narrowed down differential diagnoses. Postoperatively, the patient developed metastatic progression, as evidenced by peritoneal masses and an abdominal wall deposit on repeat CECT. She subsequently underwent adjuvant chemotherapy. SCA of the ileum poses significant diagnostic challenges due to nonspecific clinical features and its rarity. This case underscores the diagnostic complexities and therapeutic challenges of ileal SCA. Collaborative research is essential to develop effective treatment strategies for this rare malignancy.
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Affiliation(s)
- J K G Madhawa
- Department of Surgery, Colombo South Teaching Hospital, Colombo, LKA
| | - H Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, LKA
| | | | - Vinod Saranga
- Department of Surgery, Colombo South Teaching Hospital, Colombo, LKA
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2
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Diniz-Filho JF, Silva ACM, Teixeira AL, Sousa BLN, Santos-Oliveira R, Silva GEB, dos Santos CC, Alencar LMR. Penile Cancer: Innovations in Ultrastructural and Vibrational Markers. ACS OMEGA 2025; 10:3449-3461. [PMID: 39926554 PMCID: PMC11800048 DOI: 10.1021/acsomega.4c07293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 01/13/2025] [Accepted: 01/17/2025] [Indexed: 02/11/2025]
Abstract
Penile cancer (PCa) is a disease that manifests predominantly as squamous cell carcinomas (SCCs), which, although rare, represents a significant public health problem, especially in regions with less socioeconomic development. One of the biggest challenges in managing this disease is the difficulty in differentiating tumor subtypes, making accurate diagnosis and treatment challenging. In this context, new characterization techniques are needed to investigate these tumors more completely. Atomic force microscopy (AFM) and Raman spectroscopy (RS) are valuable in this context, providing quantitative and qualitative ultrastructural data and vibrational signatures of the analyzed samples. In this study, AFM and RS techniques were employed to investigate subtypes of penile cancer, including the highly aggressive basaloid subtype, which is closely associated with human papillomavirus (HPV), and the sarcomatoid subtype, comparing them with nontumorous tissues. The AFM results revealed nanoscale changes in the ultrastructural properties of tumor samples, such as increased roughness in tumor tissues, with emphasis on the basaloid type associated with the HPV virus, and reduction in the surface area and volume of tumor tissues at the nanoscale, suggesting deeper tissue infiltration and greater deformability of tumor samples at the nanoscale. RS results detected significant spectral differences between normal and cancerous tissues and between tumor subtypes, particularly in vibrational modes related to proteins and lipids. Principal component analysis (PCA) confirmed a strong discriminative power between control and PCa groups. The data presented here offers new insights into the characteristics of penile tumors that, when integrated with clinical analyses, could improve the understanding of penile cancer behavior, contributing to more accurate diagnostic methods and targeted treatments.
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Affiliation(s)
- Joel Félix
Silva Diniz-Filho
- Biophysics
and Nanosystems Laboratory, Department of Physics, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
| | - Ana Caroline Muniz Silva
- Biophysics
and Nanosystems Laboratory, Department of Physics, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
| | - Antônio
Augusto Lima Teixeira
- Immunofluorescence
and Electron Microscopy Laboratory (LIME/HUUFMA), Department of Medicine, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
| | - Bruna Larissa Nolêto Sousa
- Immunofluorescence
and Electron Microscopy Laboratory (LIME/HUUFMA), Department of Medicine, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
| | - Ralph Santos-Oliveira
- Brazilian
Nuclear Energy Commission, Institute of
Nuclear Engineering, Laboratory of Nanoradiopharmacy and Synthesis
of New Radiopharmaceuticals, Rio de Janeiro 21941906, Brazil
- State
University of Rio de Janeiro, Laboratory of Radiopharmacy and Nanoradiopharmaceuticals, Rio de Janeiro 21941906, Brazil
| | - Gyl Eanes Barros Silva
- Immunofluorescence
and Electron Microscopy Laboratory (LIME/HUUFMA), Department of Medicine, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
| | - Clenilton Costa dos Santos
- Biophysics
and Nanosystems Laboratory, Department of Physics, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
| | - Luciana Magalhães Rebelo Alencar
- Biophysics
and Nanosystems Laboratory, Department of Physics, Federal University of Maranhão, São Luís, Maranhão 65080-805, Brazil
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Sumino M, Hashimoto H, Sato N, Dejima M, Sasajima Y, Sugita M, Morikawa T. Ovarian carcinosarcoma of heterologous type occurring in an endometriotic cyst with 3-year recurrence-free survival: a case report and literature review. Int Cancer Conf J 2025; 14:21-26. [PMID: 39758792 PMCID: PMC11695655 DOI: 10.1007/s13691-024-00728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/15/2024] [Indexed: 01/07/2025] Open
Abstract
A 41-year-old premenopausal woman presented to our hospital with lower abdominal distention and epigastralgia. An ovarian endometriotic cyst was noted when she was 30 years, and was only followed up until she was 36 years. Suspecting rupture of an ovarian tumor, left adnexectomy was performed. The left ovarian tumor was diagnosed as an ovarian carcinosarcoma of the heterologous type occurring in the endometriotic cyst. The carcinosarcoma was composed of an admixture of high-grade carcinomatous and sarcomatous components, including rhabdomyosarcoma. Thereafter, secondary surgery was concluded, which confirmed the tumor stage to be pT1c3. She postoperatively received 6 cycles of docetaxel/carboplatin as adjuvant chemotherapy and achieved recurrence-free survival for 40 months. Among ovarian carcinosarcomas, cases occurring in endometriotic cysts are particularly rare and may have a relatively good prognosis, because tumor cells, especially sarcoma components, tend to be confined to the ovaries. Pathological estimation of the origin of carcinosarcoma is important, because it appears to correlate with prognosis.
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Affiliation(s)
- Mikinari Sumino
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 Japan
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan
- Department of Obstetrics and Gynecology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan
| | - Hirotsugu Hashimoto
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 Japan
- Faculty of Healthcare, Tokyo Healthcare University, 4-1-17 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8648 Japan
| | - Nakako Sato
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Mihiro Dejima
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605 Japan
| | - Masatoshi Sugita
- Department of Obstetrics and Gynecology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 Japan
- Faculty of Healthcare, Tokyo Healthcare University, 4-1-17 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8648 Japan
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Saleem U, Ansari T. Sarcomatoid Carcinoma of the Small Intestine: A Case Report. Cureus 2024; 16:e68850. [PMID: 39376807 PMCID: PMC11456989 DOI: 10.7759/cureus.68850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2024] [Indexed: 10/09/2024] Open
Abstract
Sarcomatoid carcinoma of the gastrointestinal tract is an extremely rare and aggressive tumor with both epithelial and mesenchymal characteristics, and it typically has a poor prognosis. We report the case of a 74-year-old male diagnosed with sarcomatoid carcinoma of the duodenum. The patient presented with gastrointestinal bleeding and was found to have a vascular tumor in the third part of the duodenum. Initial duodenal biopsies, repeat biopsies, and extensive immunohistochemical analysis confirmed a diagnosis of sarcomatoid carcinoma. Despite radical surgery and multiple lines of chemotherapy, including carboplatin and paclitaxel, the disease demonstrated aggressive progression, ultimately leading to the patient's death two years post-diagnosis. This report highlights the challenges in diagnosing and treating sarcomatoid carcinoma of the small intestine, the limited efficacy of current therapeutic options, and the need for further research to establish effective treatment protocols.
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Affiliation(s)
- Umair Saleem
- Medical Oncology, Peterborough City Hospital, Peterborough, GBR
| | - Tayyaba Ansari
- Medical Oncology, Peterborough City Hospital, Peterborough, GBR
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Wang Y, Zhu Q, Wu Y, Li B, Su X, Xiang C, Han Y. Multiregion exome sequencing indicates a monoclonal origin of esophageal spindle-cell squamous cell carcinoma. J Pathol 2024; 264:55-67. [PMID: 39022845 DOI: 10.1002/path.6324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 05/10/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Abstract
Esophageal spindle-cell squamous cell carcinoma (ESS) is a rare biphasic neoplasm composed of a carcinomatous component (CaC) and a sarcomatous component (SaC). However, the genomic origin and gene signature of ESS remain unclear. Using whole-exome sequencing of laser-capture microdissection (LCM) tumor samples, we determined that CaC and SaC showed high mutational commonality, with the same top high-frequency mutant genes, mutation signatures, and tumor mutation burden; paired samples shared a median of 25.5% mutation sites. Focal gains were found on chromosomes 3q29, 5p15.33, and 11q13.3. Altered genes were mainly enriched in the RTK-RAS signaling pathway. Phylogenetic trees showed a monoclonal origin of ESS. The most frequently mutated oncogene in the trunk was TP53, followed by NFE2L2, KMT2D, and MUC16. Prognostic associations were found for CDC27, LRP2, APC, and SNAPC4. Our data highlight the monoclonal origin of ESS with TP53 as a potent driver oncogene, suggesting new targeted therapies and immunotherapies as treatment options. © 2024 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Yulu Wang
- Department of Pathology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Qian Zhu
- Department of Pathology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Yaqing Wu
- Kanghui Biotech Co., Ltd., Shenyang, PR China
| | - Boyi Li
- Kanghui Biotech Co., Ltd., Shenyang, PR China
| | - Xiaoxing Su
- Kanghui Biotech Co., Ltd., Shenyang, PR China
| | - Chan Xiang
- Department of Pathology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
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Shen J, Lu K, Liu F, Chen X, Chen Q, Wu B, Wang H, Ge P, Han G, Wang F, Zhang P, Yin P, Jia W, Zheng Y, Wang P, Sun F. Clinicopathologic features and surgical treatment prognosis of esophageal carcinosarcoma. Front Oncol 2024; 14:1387611. [PMID: 39234394 PMCID: PMC11371597 DOI: 10.3389/fonc.2024.1387611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Background Carcinosarcoma is a rare esophageal tumor, accounting for approximately 0.27-2.8% of malignant esophageal tumors. This study aims to investigate the clinical pathological characteristics, surgical treatment outcomes, and analysis of prognostic factors in esophageal carcinosarcoma (ECS). Methods Clinical data from sixteen patients diagnosed with esophageal sarcomatoid carcinoma who underwent surgical interventions were retrospectively analyzed. Clinical and pathological features, treatment modalities, and postoperative outcomes were systematically examined. Results Out of the 1261 patients who underwent surgical treatment for esophageal cancer, 16 cases were pathologically confirmed as carcinosarcoma. Among them, two underwent neoadjuvant chemotherapy, six received postoperative chemotherapy. Carcinosarcomas predominantly occurred in the middle (43.75%) and lower (50%) segments of the esophagus. Among the 16 cases, 10 presented as polypoid, 4 as ulcerative, and 2 as medullary types. Microscopic examination revealed coexistence and transitional transitions between sarcomatous and carcinoma components. Pathological staging showed 5 cases in stage T1, 2 in stage T2, and 9 in stage T3, with lymph node metastasis observed in 8 cases (50%). TNM staging revealed 2 cases in stage I, 9 in stage II, and 5 in stage III. The overall 1, 3, and 5-year survival rates were 86.67%, 62.5%, and 57.14%, respectively. Univariate analysis indicated that pathological N staging influenced survival rates, while multivariate analysis demonstrated that pathological N staging was an independent prognostic factor. Conclusions Carcinosarcoma is a rare esophageal tumor, accounting for approximately 0.27-2.8% of malignant esophageal tumors. Histologically, the biphasic pattern is a crucial diagnostic feature, although the carcinomatous component may not always be evident, especially in limited biopsies, leading to potential misclassification as pure sarcoma or squamous cell carcinoma. Despite its large volume and cellular atypia, carcinosarcoma carries a favorable prognosis. Complete surgical resection of the tumor and regional lymph node dissection is the preferred treatment approach for esophageal carcinosarcoma.
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Affiliation(s)
- Jiangfeng Shen
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Kaijin Lu
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Fuxing Liu
- Department of Pathology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Xia Chen
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Quan Chen
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Bingbing Wu
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Hailan Wang
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Pengfei Ge
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Guang Han
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Fei Wang
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Peng Zhang
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Pei Yin
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Weiguang Jia
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Yiming Zheng
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Pengcheng Wang
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Fei Sun
- Department of Thoracic Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
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Hu B, Zhao K, Yang Y, Zhang Y, Liu G, Zeng H, Zou B. Investigating esophageal sarcomatoid carcinoma and its comparison with esophageal squamous cell carcinoma on clinicopathological characteristics, prognosis, and radiomics features: a retrospective study. Front Oncol 2024; 14:1398982. [PMID: 39011471 PMCID: PMC11247005 DOI: 10.3389/fonc.2024.1398982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/05/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Esophageal sarcomatoid carcinoma (ESC) is a rare pathological subtype of esophageal carcinomas, wherein its epithelial component typically demonstrates squamous cell carcinoma (SCC). However, the clinicopathological features and prognosis of ESC remain unclear, alongside its unique aspects compared to esophageal SCC (ESCC). Methods Between January 2008 and December 2018, we retrospectively reviewed 67 ESC patients treated at West China Hospital. Among them, 51 patients with resected ESC were matched with 98 resected ESCC patients over the same period using propensity score matching at 1:2. The survival time and radiomics features of the two groups were compared. Results A total of 59 patients with resected ESC and eight patients with non-resected ESC were enrolled. Progression-free survival (PFS) and overall survival (OS) were significantly different in patients with different TNM stages (p < 0.001). A multivariate analysis showed that length of tumor was an independent factor for OS in resetable ESC (p = 0.041). Among matched ESC and ESCC patients, OS was significantly longer for patients with ESC than those with ESCC (5-year OS, 61.1% vs. 43.6%; HR 0.59, 95% CI 0.35-0.96; p = 0.032). A Rad-score for discriminating ESC from ESCC containing two CT-derived radiomics features was developed [area under the curve: 0.823 (95% CI 0.732-0.913) in the training cohort and 0.828 (95% CI 0.636-1.000) in the validation cohort, respectively]. Conclusions ESC has a better prognosis when compared with ESCC. By developing a radiomics prediction model, we provide reliability and convenience for the differential diagnosis of ESC from ESCC.
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Affiliation(s)
- Binbin Hu
- Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kejia Zhao
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, Sichuan, China
| | - Yushang Yang
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- Research Core Facility of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guihong Liu
- Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haiyan Zeng
- Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bingwen Zou
- Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Shibata Y, Ohmura H, Komatsu K, Sagara K, Matsuyama A, Nakano R, Baba E. Myocardial metastasis from ZEB1- and TWIST-positive spindle cell carcinoma of the esophagus: A case report. World J Gastroenterol 2024; 30:1636-1643. [PMID: 38617457 PMCID: PMC11008411 DOI: 10.3748/wjg.v30.i11.1636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/02/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Metastatic cardiac tumors are known to occur more frequently than primary cardiac tumors, however, they often remain asymptomatic and are commonly discovered on autopsy. Malignant tumors with a relatively high frequency of cardiac metastasis include mesothelioma, melanoma, lung cancer, and breast cancer, whereas reports of esophageal cancer with cardiac metastasis are rare. CASE SUMMARY The case of a 60-year-old man who complained of dysphagia is presented. Upper gastrointestinal endoscopy showed a submucosal tumor-like elevated lesion in the esophagus causing stenosis. Contrast-enhanced computed tomography showed left atrial compression due to the esophageal tumor, multiple liver and lung metastases, and a left pleural effusion. Pathological examination of a biopsy specimen from the esophageal tumor showed spindle-shaped cells, raising suspicion of esophageal sarcoma. The disease progressed rapidly, and systemic chemotherapy was deemed necessary, however, due to his poor general condition, administration of cytotoxic agents was considered difficult. Given his high Combined Positive Score, nivolumab was administered, however, the patient soon died from the disease. The autopsy confirmed spindle cell carcinoma (SCC) of the esophagus and cardiac metastasis with similar histological features. Cancer stem cell markers, ZEB1 and TWIST, were positive in both the primary tumor and the cardiac metastasis. CONCLUSION To the best of our knowledge, there have been no prior reports of cardiac metastasis of esophageal SCC. This case highlights our experience with a patient with esophageal SCC who progressed rapidly and died from the disease, with the autopsy examination showing cardiac metastasis.
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Affiliation(s)
- Yoshihiro Shibata
- Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan
| | - Hirofumi Ohmura
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Kazuki Komatsu
- Department of Pathology and Oncology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Kosuke Sagara
- Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan
| | - Atsuji Matsuyama
- Department of Diagnostic Pathology, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan
| | - Ryuji Nakano
- Department of Diagnostic Pathology, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
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Al-Nattah S, Matkovic E, Schwalbe M, Matkowskyj KA. Pathologic Features of Esophageal and Gastric Malignancies. Cancer Treat Res 2024; 192:19-48. [PMID: 39212914 DOI: 10.1007/978-3-031-61238-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Esophageal cancer is the eighth most common cancer globally, affecting approximately 570,000 people worldwide and currently ranking sixth among cancer-related mortality (Uhlenhopp et al. in, Clin J Gastroenterol 13:1010-1021, 2020). The prognosis is poor as many patients present with locally incurable or metastatic disease. In spite of advancements in treatment, the overall 5-year survival rates are in the realm of 10% whereas the 5-year post-esophagectomy survival rates are in the realm of 15-40% [2]. The incidence rates vary dramatically worldwide, which can be attributed to demographic and socioeconomic factors. Although the vast majority of esophageal neoplasms arise from the epithelial layer and include squamous cell carcinoma (SCC) and adenocarcinoma (AC), a subset of neuroendocrine and soft tissue tumors can also occur in the esophagus. Several tasks are presented to the surgical pathologist when dealing with esophageal carcinoma that include rendering a diagnosis, classifying the histological type, and assessing prognostic factors. This narrative review aims to evaluate current literature on various esophageal neoplasms and highlight pathological factors that impact clinical decision making and prognosis.
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Affiliation(s)
- Sanaa Al-Nattah
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Quest Diagnostics, Las Vegas, NV, USA
| | - Eduard Matkovic
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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10
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Chen T, Li W, Fan J. A Case of Primary Esophageal Sarcomatoid Carcinoma Detected by 18F-FDG PET/CT. Clin Nucl Med 2023; 48:910-912. [PMID: 37682610 DOI: 10.1097/rlu.0000000000004813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT Primary sarcomatoid carcinoma of the esophagus is a rare and highly malignant neoplasm with a poor prognosis. A 51-year-old man presented with difficulty in swallowing for 2 weeks. Thoracic CT revealed a huge mass in the middle-lower thoracic esophagus. 18F-FDG PET/CT showed intense 18F-FDG uptake of the esophageal tumor. Histopathology and immunohistochemistry of the esophageal lesion tissue confirmed the diagnosis of sarcomatoid carcinoma after postoperative pathological biopsy.
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Affiliation(s)
- Tao Chen
- From the Department of Nuclear Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province
| | - Wenfei Li
- Department of Radiology, the First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Jianzhong Fan
- From the Department of Nuclear Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province
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11
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Li C, Tian Y, Chen J, Wen B, He Y. An Unusual Case of Esophageal Carcinosarcoma on 18F-FDG PET/CT. Clin Nucl Med 2021; 46:659-660. [PMID: 33512947 DOI: 10.1097/rlu.0000000000003514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Carcinosarcoma of the esophagus is a rare malignant neoplasm. Here, we report a case of esophageal carcinosarcoma with lymphatic and pulmonary metastases on 18F-FDG PET/CT in a 64-year-old woman.
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Affiliation(s)
- Chongjiao Li
- From the Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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12
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Kato F, Koyanagi K, Sugihara S, Nakagawa T, Hayashi K, Shintoku J. Long-term survival case of esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis successfully treated by staged operation: A case report. Int J Surg Case Rep 2021; 83:105946. [PMID: 33975200 PMCID: PMC8129925 DOI: 10.1016/j.ijscr.2021.105946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with esophageal cancers including carcinosarcoma sometimes have underlying liver cirrhosis because of a history of heavy drinking. It is definitely required to determine the appropriate surgical strategy and to manage the patients promptly when performing esophagectomy for the esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis. PRESENTATION OF CASE A 56-year-old male patient with a history of chest pain and difficulty swallowing was admitted to our hospital. He had a history of drinking 250 g of alcohol per day. Endoscopy revealed an irregular protruding tumor on the left wall of the lower-third thoracic esophagus. Computed tomography showed a tumor lesion in the lower-third thoracic esophagus; the images also showed irregularities on the surface of the liver, suggestive of coexisting alcoholic liver cirrhosis. The preoperative diagnosis was T3N2M0, Stage III esophageal leiomyosarcoma. In consideration of the underlying alcoholic liver cirrhosis, a staged operation was planned for this patient as a curative treatment. The patient had an uneventful postoperative clinical course and was discharged on the 47th day after the first surgery. Final histopathological diagnosis was T2N0M0, Stage II esophageal carcinosarcoma. The patient is alive without recurrence three years after surgery. DISCUSSION This is the first report of long-term survival case of esophageal carcinosarcoma with alcoholic liver cirrhosis that was treated successfully by staged operation. CONCLUSIONS Despite coexisting with alcoholic liver cirrhosis, staged operation could reduce the surgical invasiveness, so that very good short-term outcome and long-term survival was obtained in the patient with esophageal carcinosarcoma.
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Affiliation(s)
- Fumihiko Kato
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | | | - Tomohiko Nakagawa
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
| | - Koji Hayashi
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
| | - Junichi Shintoku
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
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13
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Savant D, Zhang Q, Yang Z. Squamous Neoplasia in the Esophagus. Arch Pathol Lab Med 2021; 145:554-561. [PMID: 32271610 DOI: 10.5858/arpa.2020-0058-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Squamous lesions of the esophagus encompass a spectrum of disorders ranging from reactive changes and benign papilloma to squamous dysplasia and squamous cell carcinoma, which may pose diagnostic challenges especially in superficial biopsies. OBJECTIVE.— To provide a review on the typical features of squamous neoplasia in the esophagus, with an emphasis on the key diagnostic features as well as differential diagnosis from mimicking lesions. DATA SOURCES.— Data sources include published peer-reviewed literature and personal experiences of the authors. CONCLUSIONS.— Accurate diagnosis of squamous neoplasia requires adherence to established diagnostic criteria, attention to subtle histologic features, and correlation with clinical and imaging findings. In difficult cases, multiple biopsies may be necessary to reach a definitive diagnosis.
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Affiliation(s)
- Deepika Savant
- The Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Savant, Yang)
| | - Qingzhao Zhang
- The Department of Pathology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania (Zhang)
| | - Zhaohai Yang
- The Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Savant, Yang)
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14
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Fu Y, Wang PP, He D, Zheng Y, Ding ZY. Major pathological response after neoadjuvant immunotherapy in esophageal spindle cell carcinoma: A case report. Thorac Cancer 2021; 12:1234-1239. [PMID: 33619875 PMCID: PMC8046125 DOI: 10.1111/1759-7714.13905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 02/05/2023] Open
Abstract
Esophageal spindle cell carcinoma (ESpCC) is a rare subtype of esophageal carcinoma, accounting for 1% of all esophageal malignancies. The clinical outcome is unknown due to the lack of treatment options. Here, we present the case of a 60‐year‐old male with initially unresectable ESpCC, in which platinum‐based concurrent chemoradiotherapy was unsuccessful. He was subsequently treated with neoadjuvant immunotherapy and after surgery achieved a complete pathological response; therefore, neoadjuvant immunotherapy might be a novel option for ESpCC patients.
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Affiliation(s)
- Yang Fu
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Pei-Pei Wang
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Du He
- Department of Pathology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yue Zheng
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Zhen-Yu Ding
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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15
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Lam AKY. Updates on World Health Organization classification and staging of esophageal tumors: implications for future clinical practice. Hum Pathol 2021; 108:100-112. [PMID: 33157124 DOI: 10.1016/j.humpath.2020.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
The Fifth edition of the World Health Organization classification of digestive system and American Joint Committee on Cancer staging manual contain substantial refinements of information for esophageal tumors. The epithelial tumors of esophagus are classified as benign, dysplasia, and malignant groups. Dysplasia is divided into Barrett dysplasia and squamous dysplasia and graded into either low-grade or high-grade. Malignant esophageal tumors are often adenocarcinoma or squamous cell carcinoma. The main update in cancer staging in esophageal tumors is the subdivision of the prognostic staging into 3 groups; squamous cell carcinoma, adenocarcinoma, and carcinoma after adjuvant therapy. HER-2 amplification is recognized as a molecular target for therapy of esophagogastric adenocarcinoma. The other esophageal tumors are adenoid cystic carcinoma, mucoepidermoid/adenosquamous carcinoma, undifferentiated carcinoma and neuroendocrine neoplasms. Overall, the incorporation of new data and definitions on histopathology, prognostic factors, and genetics are important for personalized management of patients with esophageal tumors.
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Affiliation(s)
- Alfred King-Yin Lam
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4209, Australia.
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16
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Grillo F, Mastracci L, Saragoni L, Vanoli A, Limarzi F, Gullo I, Ferro J, Paudice M, Parente P, Fassan M. Neoplastic and pre-neoplastic lesions of the oesophagus and gastro-oesophageal junction. Pathologica 2020; 112:138-152. [PMID: 33179618 PMCID: PMC7931575 DOI: 10.32074/1591-951x-164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
Oesophageal and gastro-oesophageal junction (GOJ) neoplasms, and their predisposing conditions, may be encountered by the practicing pathologist both as biopsy samples and as surgical specimens in daily practice. Changes in incidence of oesophageal squamous cell carcinomas (such as a decrease in western countries) and in oesophageal and GOJ adenocarcinomas (such as a sharp increase in western countries) are being reported globally. New modes of treatment have changed our histologic reports as specific aspects must be detailed such as in post endoscopic resections or with regards to post neo-adjuvant therapy tumour regression grades. The main aim of this overview is therefore to provide an up-to-date, easily available and clear diagnostic approach to neoplastic and pre-neoplastic conditions of the oesophagus and GOJ, based on the most recent available guidelines and literature.
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Affiliation(s)
- Federica Grillo
- Correspondence Federica Grillo Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DICS), University of Genova and Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, largo Rosanna Benzi 10, 16132 Genova, Italy Tel. +39 010 5555957 Fax: +39 010 5556392 E-mail:
| | | | - Luca Saragoni
- UO Anatomia Patologica, Ospedale G.B. Morgagni-L. Pierantoni, Forlì, Italy
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Francesco Limarzi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST/IRCCS), Meldola (FC), Italy
| | - Irene Gullo
- Department of Pathology, Centro Hospitalar Universitário de São João (CHUSJ) & Department of Pathology, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal and Instituto de Investigação e Inovação em Saúde (i3S) & Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
| | - Jacopo Ferro
- Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DICS), University of Genova, Italy
| | - Michele Paudice
- Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DICS), University of Genova, Italy
| | - Paola Parente
- Unit of Pathology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Italy
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17
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Abstract
Histological assessment of esophageal squamous malignancies is crucial for management of patients with the cancer as well as working in research on the cancer. The squamous malignancies in the esophagus comprise squamous dysplasia and squamous cell carcinoma. Current classification of squamous dysplasia in the esophagus is to divide it into low grade and high grade. Most of the esophageal squamous cell carcinomas are of conventional type and divided into well, moderately, and poorly differentiated. The variants of esophageal squamous cell carcinoma include basaloid squamous carcinoma, spindle cell carcinoma, and verrucous carcinoma. Preoperative chemoradiation is used commonly in the treatment of esophageal squamous cell carcinoma and induces changes in morphology. Tumor regression grading systems based on the percentage of the remaining carcinoma cells are used to assess the response to the neoadjuvant therapy in the cancer. Additional histological parameters including lymphovascular invasion, perineural invasion, clearance of resection margins, and carcinoma in the nodal and distant metastatic sites provide essential information for the management of the patient with the cancer.
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Affiliation(s)
- Alfred K Lam
- Cancer Molecular Pathology, School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
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18
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A unique case of esophageal carcinosarcoma with histopathological diversities. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Phelps BJ, Tiley YM, Skrove JL, Berry AC, Mohan K. Acute Dysphagia Caused by Sarcomatoid Squamous Cell Carcinoma of the Esophagus. Cureus 2019; 11:e4129. [PMID: 31058012 PMCID: PMC6485518 DOI: 10.7759/cureus.4129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sarcomatoid squamous cell carcinoma of the esophagus is a rare etiology of esophageal cancer. Due to its large polypoid character, patients suffering from this disease typically present with progressive dysphagia, weight loss, odynophagia, or chest pain. Risk factors for esophageal cancer include smoking, alcohol use, and chronic gastroesophageal reflux disease. We present a case of an elderly female who presented to our hospital with a one-week history of progressive dysphagia secondary to a large esophageal sarcomatoid squamous cell carcinoma.
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Affiliation(s)
| | - Yale M Tiley
- Internal Medicine, Palmetto General Hospital, Hialeah, USA
| | - Jamie L Skrove
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Andrew C Berry
- Gastroenterology, Larkin Community Hospital, South Miami, USA
| | - Karthik Mohan
- Gastroenterology, Palmetto General Hospital, Hialeah, USA
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20
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Nagano H, Izumi T, Kawahara E, Oyama T, Goi T. SMARCB1- and vimentin-positive esophageal carcinoma with undifferentiated components, rhabdoid features, and a good prognosis: a case report. Surg Case Rep 2019; 5:8. [PMID: 30649642 PMCID: PMC6335233 DOI: 10.1186/s40792-019-0562-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Undifferentiated carcinoma of the esophagus with rhabdoid features is a very rare histologic finding that is occasionally associated with the loss of SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 (SMARCB1); however, until now, few survey reports of this type of tumor have been published. In this study, we describe a case of esophageal carcinoma with undifferentiated components and rhabdoid features that was exclusively positive for vimentin and SMARCB1 in a patient with prolonged survival. CASE PRESENTATION A 67-year-old man complained of a stomachache and loss of appetite persisting for 1 month. He was then admitted to the hospital. Diagnostic imaging studies revealed a transdiaphragmatic circular ulcerative tumor of the esophagogastric region. Biopsy specimens showed undifferentiated round cell carcinoma. The patient underwent lower esophageal resection and total gastrectomy with lymph node dissection. Microscopic analysis revealed that most of the primary tumor consisted of large undifferentiated round cells and scattered rhabdoid cells. The tumor invaded the muscular layer in the esophagus and the subserosal layer in the stomach, and metastasis was noted in only one lymph node. Immunohistochemical analysis revealed that the round and rhabdoid cells found in the primary tumor were diffusely positive for SMARCB1 and vimentin. The tumor displayed focal positivity for the anti-pan-cytokeratin antibody AE1/AE3. In the positive lymph node, round undifferentiated carcinoma cells were admixed with squamous carcinoma cells that were positive for cytokeratin 5/6 and 34βE12. The MIB-1 index was 19.7% and 0.5% for the round cells from the primary tumor and epithelial cells from the metastatic lymph node lesion, respectively, and 70.1% for the round cells from the metastatic lymph node lesion. The patient has been alive for 10 years after surgery without tumor recurrence. CONCLUSIONS We reported a rare case of esophageal carcinoma with undifferentiated components, rhabdoid features, and a good prognosis.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, Fukui General Hospital, 58-16-1 Egami-cho, Fukui, 910-3113, Japan. .,Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, 2-6-21 Nagayama-cho, Katsuyama, Fukui, Japan.
| | - Toshimasa Izumi
- Department of Surgery, Fukui General Hospital, 58-16-1 Egami-cho, Fukui, 910-3113, Japan
| | - Ei Kawahara
- Department of Pathology, Fukui General Hospital, 58-16-1 Egami-cho, Fukui, 910-3113, Japan
| | - Takeru Oyama
- Department of Pathology, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takanori Goi
- 1st Department of Surgery, Faculty of Medicine, University of Fukui, 23-3 Matsuokashimoaizuki, Yoshida-gun, Eiheiji-cho, Fukui, 910-1193, Japan
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21
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Pateria P, Muwanwella N, Chai M, Venugopal K. Synchronous oesophageal and gastric sarcomatoid carcinoma: first reported case in Australia. BMJ Case Rep 2018; 2018:bcr-2018-225092. [PMID: 29804085 DOI: 10.1136/bcr-2018-225092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 75-year-old retired teacher presents with dysphagia and weight loss for a duration of 6 months. Her gastroscopy showed two synchronous submucosal masses. A 7 cm polypoid mass was seen at the distal oesophagus, arising from a thick stalk and a 4 cm mass seen at the cardia. The biopsies showed high-grade sarcomatoid cancer. Staging CT scan and Positron Emission Tomography scan did not show any distant metastasis except a lesion in the rectum that was subsequently found to be tubulovillous adenoma on transanal excision. The patient was managed with Ivor Lewis oesophagectomy. The biopsies of resection specimen showed spindle cell/sarcomatoid carcinoma with a component of poorly differentiated neuroendocrine carcinoma in oesophageal tumour and a small component of conventional invasive squamous cell carcinoma in tumour at cardia. The patient recovered well after surgery. Since then, she has completed adjuvant chemoradiotherapy. No recurrence has been noted in 10 months follow-up.
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Affiliation(s)
- Puraskar Pateria
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Niroshan Muwanwella
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ming Chai
- Anatomical Pathology, PathWest Laboratory Medicine Western Australia, Nedlands, Western Australia, Australia
| | - Kannan Venugopal
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
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22
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Li XM, Song X, Zhao XK, Hu SJ, Cheng R, Lv S, Du DF, Zhang XY, Lu JL, Ku JW, Zhang DY, Zhang Y, Fan ZM, Wang LD. The alterations of cytokeratin and vimentin protein expressions in primary esophageal spindle cell carcinoma. BMC Cancer 2018; 18:356. [PMID: 29609569 PMCID: PMC5880062 DOI: 10.1186/s12885-018-4301-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background The accumulated evidence has indicated the diagnostic role of cytokeratin (CK) and vimentin protein immunoassay in primary esophageal spindle cell carcinoma (PESC), which is a rare malignant tumor with epithelial and spindle components. However, it is largely unknown for the expression of CK and vimentin in pathological changes and prognosis of PESC. Methods Eighty-two PESC patients were identified from the esophageal and gastric cardia cancer database established by Henan Key Laboratory for Esophageal Cancer Research of Zhengzhou University. We retrospectively evaluated CK and vimentin protein expressions in PESC. Clinicopathological features were examined by means of univariate and multivariate survival analyses. Furthermore, the co-expression value of cytokeratin and vimentin was analyzed by receiver operating characteristic (ROC) curve. Results The positive pan-cytokeratins AE1/AE3 (AE1/AE3 for short) staining was chiefly observed in cytoplasm of epithelial component tumor cells, with a positive detection rate of 85.4% (70/82). Interestingly, 19 cases showed AE1/AE3 positive staining both in epithelial and spindle components (23.2%). However, AE1/AE3 expression was not observed with any significant association with age, gender, tumor location, gross appearance, lymph node metastasis and TNM stage. Furthermore, AE1/AE3 protein expression does not show any effect on survival. Similar results were observed for vimentin immunoassay. However, in comparison with a single protein, the predictive power of AE1/AE3 and vimentin proteins signature was increased apparently than with single signature [0.75 (95% CI = 0.68–0.82) with single protein v.s. 0.89 (95% CI = 0.85–0.94) with AE1/AE3 and vimentin proteins]. The 1-, 3-, 5- and 7-year survival rates for PESC patients in this study were 79.3%, 46.3%, 28.0% and 15.9%, respectively. Multivariate analysis demonstrated age and TNM stage were independent prognostic factors for overall survival (P = 0.036 and 0.003, respectively). It is noteworthy that only 17.1% patients had a PESC accurate diagnosis by biopsy pathology before surgery (14/82). 72.4% PESC patients with biopsy pathology before surgery had been diagnosed as squamous cell carcinoma. Conclusion The present study demonstrates that cytokeratin and vimentin protein immunoassay is a useful biomarker for PESC accurate diagnosis, but not prognosis. The co-expression of cytokeratin and vimentin in both epithelial and spindle components suggest the possibility of single clone origination for PESC.
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Affiliation(s)
- Xin Min Li
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Xin Song
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Xue Ke Zhao
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Shou Jia Hu
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Rang Cheng
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Shuang Lv
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China.,Department of Pathology, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Dan Feng Du
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China.,Department of Pathology of Basic Medical College, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Xiang Yang Zhang
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Jian Liang Lu
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China.,Department of Pathology, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Jian Wei Ku
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China.,Department of Gastroenterology, the Second Affiliated Hospital of Nanyang Medical College, Nanyang, 473061, Henan, China
| | - Dong Yun Zhang
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China.,Department of Pathology of Nanyang Medical College, Nanyang, 473061, Henan, China
| | - Yao Zhang
- Department of Pathology, Women & Infants Hospital of Zhengzhou, Zhengzhou, 450012, Henan, China
| | - Zong Min Fan
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China
| | - Li Dong Wang
- Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital, Zhengzhou University, 40 Daxue Road, Zhengzhou, Henan, 450052, People's Republic of China.
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Yoshimoto T, Kobayashi S, Kanetaka K, Kobayashi K, Nagata Y, Morita M, Isagawa Y, Kinoshita N, Takatsuki M, Eguchi S. Preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for locally advanced esophageal carcinosarcoma: a case report and review of the literature. Surg Case Rep 2018; 4:18. [PMID: 29455418 PMCID: PMC5816731 DOI: 10.1186/s40792-018-0425-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/05/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Esophageal carcinosarcoma is a relatively rare malignant neoplasm composed of both epithelial carcinomatous and mesenchymal sarcomatous elements. There is no recommended clinical treatment for esophageal carcinosarcoma because of the rarity of the disease. This report describes a case of esophageal carcinosarcoma that was effectively treated with docetaxel, cisplatin, and 5-fluorouracil as preoperative chemotherapy. CASE PRESENTATION A 73-year-old man had a chief complaint of dysphagia with epigastric pain. Esophagogastroduodenoscopy (EGD) revealed a polypoid neoplasm combined with an infiltrative ulcer that exhibited a mixture of squamous cell carcinoma and spindle cell sarcoma histologically. Computed tomography findings showed swollen lymph nodes in the mediastinum and around the cardia. We diagnosed esophageal carcinosarcoma cT3N1M0 cStage III. After preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil, the patient underwent thoracoscopic esophagectomy with three-field lymph node dissection. Histological findings revealed that the sarcomatous component had completely disappeared and the carcinomatous component was only confined by the basement membrane with scar formation of the muscularis propria. Mural fibrotic lesions were observed in several resected regional lymph nodes. Hence, immediately after preoperative therapy, the esophageal carcinosarcoma was diagnosed as ypTisN0M0 fStage I. The patient remained alive without tumor recurrence at 12 months after the operation. CONCLUSIONS A review of the literature revealed that there is still no established therapeutic strategy for locally advanced esophageal carcinosarcoma, especially against the sarcomatous component. We herein provide the first report in which the sarcomatous component showed a complete response to preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil. Preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by esophagectomy with extended lymphadenectomy may achieve definitive treatment for locally advanced esophageal carcinosarcoma.
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Affiliation(s)
- Tomoko Yoshimoto
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Kazuma Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Yasuhiro Nagata
- Center for Comprehensive Community Care Education, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Michi Morita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Yuriko Isagawa
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Naoe Kinoshita
- Department of Pathology, Saiseikai Nagasaki Hospital, Katafuchi 2-5-1, Nagasaki, 850-0003, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan.
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Saeger W, Mohren W, Behrend M, Iglauer P, Wilczak W. Sarcomatoid Adrenal Carcinoma: Case Report with Contribution to Pathogenesis. Endocr Pathol 2017; 28:139-145. [PMID: 27688079 DOI: 10.1007/s12022-016-9450-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A tumor in the adrenal region with two metastases in the liver was classified as poorly differentiated sarcoma on the base of extensive immunostainings (expression of vimentin, desmin, myogenin, and CD31, no expression of inhibin, melan A). Four years later in a second examination with molecular methods for a study of adrenal sarcomas, this diagnosis must be revised due to the lack of MDM-2 gene amplification and FKHR translocation which exclude sarcoma. Further immunostainings of many other parts of the tumor showed in one area more mature tumor tissue expressing synaptophysin, SF-1, and melan A. From these findings we classified an adrenal cortical cancer with predominant dedifferentiation into a sarcomatoid adrenal carcinoma. The properties of this very rare cancer type are presented and discussed.
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Affiliation(s)
- Wolfgang Saeger
- Institute of Pathology and Neuropathology of the University of Hamburg, Martinistraße 52, 20246, Hamburg, UKE, Germany.
| | - Werner Mohren
- Institute of Pathology, Hospital Deggendorf, 94469, Deggendorf, Germany
| | - Matthias Behrend
- Clinic for Surgery, Hospital Deggendorf, 94469, Deggendorf, Germany
| | - Peter Iglauer
- Institute of Pathology of the University of Hamburg, 20246, Hamburg, UKE, Germany
| | - Waldemar Wilczak
- Institute of Pathology of the University of Hamburg, 20246, Hamburg, UKE, Germany
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Abstract
Esophageal cancer is a serious malignancy with high mortality. The two common distinctive pathologic subtypes of esophageal cancer are squamous cell carcinoma and adenocarcinoma. These differ with regards to etiology, ethnic distribution, pathogenesis, and location in the esophagus. The precursor lesions are also unique to each subtype. Squamous cell carcinoma is more common in East Asia, is linked to smoking and tobacco use, more commonly involves the middle esophagus, and the precursor lesion is squamous dysplasia. Adenocarcinoma is more common in the United States and certain European countries, associated with obesity and gastroesophageal reflux disease (GERD), more commonly involves the distal esophagus, and the precursor lesion is Barrett's esophagus. Endoscopic surveillance with biopsy evaluation is the standard of care in high-risk groups. Endoscopic ablative therapies for early cancers have lower morbidity than surgery. Despite increased awareness, identification of high-risk groups and endoscopic surveillance, a large proportion of patients present with advanced cancers. Surgery and chemoradiation, either in neo-adjuvant or adjuvant setting, is the usual treatment for patients with advanced but resectable esophageal cancers. The prognosis and further management largely depends upon the pathologic tumor-node-metastasis (TNM) staging provided by the American Joint Committee on Cancer (AJCC) and the International Union against Cancer. Currently, the 7th edition of TNM staging system is being applied for prognostication and this is more focused on pathologic evaluation. Eighth edition of AJCC/UICC TNM staging has been introduced and will be implemented for clinical use in 2018.
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Affiliation(s)
- Shilpa Jain
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sadhna Dhingra
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
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26
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Xu X, Lin M, Wang S, Jin Z, Han S, Liu X, Gao Y. Lung Sarcomatoid Carcinoma Metastasis to Skin: A Case Report and Review of the Literature. Cancer Invest 2016; 34:286-92. [PMID: 27348718 DOI: 10.1080/07357907.2016.1193744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sarcomatoid carcinoma is a biphasic neoplasm composed of highly complex, intimately admixed malignant epithelial and mesenchymal elements. We herein report a rare case of cutaneous metastasis of pulmonary sarcomatoid carcinoma that contains liposarcomatous, rhabdosarcomatous and chondrosarcomatous heterologous differentiation, and review relevant literatures to lead to a better understanding of this rare but highly aggressive tumor.
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Affiliation(s)
- Xuezhu Xu
- a Department of Dermatology , the Second Hospital of Dalian Medical University , Dalian , China
| | - Mao Lin
- a Department of Dermatology , the Second Hospital of Dalian Medical University , Dalian , China
| | - Shengyi Wang
- a Department of Dermatology , the Second Hospital of Dalian Medical University , Dalian , China
| | - Zeyu Jin
- b The Clinical Medical College, Shanghai Jiao Tong University , Shanghai , China
| | - Shixin Han
- c Department of Dermatology , First Affiliated Hospital of Dalian Medical University , Dalian , China
| | - Xia Liu
- a Department of Dermatology , the Second Hospital of Dalian Medical University , Dalian , China
| | - Yuxue Gao
- a Department of Dermatology , the Second Hospital of Dalian Medical University , Dalian , China
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27
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Choe JW, Jung SW, Lee SW. An unusual case of progressive dysphagia. Gastroenterology 2015; 149:1337-8. [PMID: 26409240 DOI: 10.1053/j.gastro.2015.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/20/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Jung Wan Choe
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Woo Jung
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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28
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Surgical Resection of Rare Esophageal Cancers. Ann Thorac Surg 2015; 101:311-5. [PMID: 26277558 DOI: 10.1016/j.athoracsur.2015.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although surgical resection of adenocarcinoma or squamous cell carcinoma of the esophagus is standard practice, the treatment strategy for other malignant rare esophageal cancers is still under debate. The aim of this study was to examine the treatment of rare malignant esophageal cancers and to evaluate the survival of these patients. METHODS A retrospective review of all esophagectomies performed at Mayo Clinic from 1980 to 2014 (approximately 4,000 cases) identified 24 patients with histologic features other than adenocarcinoma or squamous cell carcinoma. Their medical records were reviewed for demographics, presenting symptoms, evaluation, surgical management, pathologic features, and short-term and long-term outcome. RESULTS Pathologic identifications included small cell carcinoma, lymphoma, and undifferentiated carcinoma in 4 (16.7%) patients each and neuroendocrine, melanoma, leiomyosarcoma, sarcomatoid, sarcoma, and gastrointestinal stromal tumor in 2 (8.3%) patients each. The most common presenting symptoms included dysphasia in 91.7% patients (22/24), pain in 75.0% (18/24), and weight loss in 62.5% (15/24). Preoperative evaluation included barium swallow in 91.7% (22/24), computed tomography in 91.7% (22/24), positron emission tomography in 54.2% (13/24), esophagogastroduodenoscopy in 100% (24/24), and endoscopic ultrasonography in 29.2% (7/24) patients. The location of the tumor was at the gastroesophageal junction in 41.7% (10/24). There was no operative mortality, and 13 patients (54.16%) had at least one postoperative adverse event. The 1-year survival after esophagectomy was 69.7%, the 5-year survival was 42.7%, and the 10-year survival was 37.4%. CONCLUSIONS Esophageal cancer with pathologic features other than squamous cell carcinoma or adenocarcinoma is rare. Esophagectomy for rare types of malignant esophageal cancers should be considered part of the effective treatment paradigm.
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29
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Tamura H, Doi R, Adachi S. Polypoid extrahepatic bile duct carcinoma morphologically indistinguishable from benign giant cell tumor. Pathol Int 2015; 66:114-7. [DOI: 10.1111/pin.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hiromi Tamura
- Department of Pathology; City Hospital of Toyonaka; Toyonaka Japan
| | - Reiko Doi
- Department of Pathology; City Hospital of Toyonaka; Toyonaka Japan
| | - Shiro Adachi
- Department of Pathology; City Hospital of Toyonaka; Toyonaka Japan
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30
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Abstract
A group of tumors referred to as atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) predominantly occur in sun-damaged skin of the elderly, particularly in the head and neck region. Although this group of tumors is often regarded as of mesenchymal phenotype, the matter of histogenesis has not been entirely resolved. Evans H and Smith JL reported in 1980 that prognosis was not significantly different irrespective of whether there was a definite squamous cell carcinoma component or not, supporting a view that these are all carcinomata in nature (sarcomatoid carcinoma [SC]). There are a number of clinicopathologic studies of AFX in the literature but information on morphologically similar sarcoma-like tumors with immunohistochemical evidence of epithelial differentiation is sparse. One hundred sarcoma-like tumors (SLTs) of head and neck skin of the elderly, treated by surgical excision, were studied. Clinical information was obtained, and pathology reports and hematoxylin and eosin sections were reviewed to document size (maximum dimension), extent of invasion, mitotic count, vascular and perineural invasion, margin status, ulceration, necrosis, and the presence of actinic keratosis in adjacent/overlying skin. Immunostains examined included: pan-cytokeratins (CKs) (AE1/AE3, MNF116), high-molecular weight CKs (34βE12, CK5/6, CK14), p63, and melanocytic (S100, Melan A, HMB-45, MITF), vascular (CD31, CD34), and muscle markers (SMA, desmin, h-caldesmon) to exclude melanoma and definite sarcoma entities. The tumors were divided into AFX/PDS (G1), the SC group, which was subdivided into SLT with only p63 positivity (G2a) and SLT with CK positivity regardless of p63 status (G2b), and SLT with a minor morphologic squamous cell carcinoma component (G3). Clinicopathologic findings of each group were compared, in relation to outcomes. Age at diagnosis ranged from 51 to 96 years (median, 79 y), with M:F=11.5:1. There were 53 tumors in G1 (19AFX, 34PDS), 37 in G2 (25 in G2a, 12 in G2b), and 10 in G3. There was no statistically significant difference in clinical and pathologic parameters or survival among all 3 groups. CKs and p63 expression, size, extent of invasion, vascular invasion, perineural invasion, mitotic count, and ulcer did not affect outcome, whereas margin status and necrosis did by both univariate and multivariate analysis and by only univariate analysis, respectively. Sixty patients had multiple nonmelanomatous skin cancers. Actinic keratosis was observed in overlying/adjacent epidermis in 51 cases. Eight patients had prior radiotherapy to head skin cancers; 1 patient developed 2 separate tumors (G1 and G3) after radiotherapy. Four patients died of tumor (1 G1, 2 G2b, and 1 G3); of these, 3 cases had positive margin, and 1 had narrow margin. Our results have shown similarities of various clinicopathologic parameters between AFX/PDS and SC, raising the possibility that both entities are related, and some of the former entities may represent complete dedifferentiation (complete loss of epithelial phenotype) with a gain of mesenchymal phenotype. In addition, the difference between AFX and PDS appears to be the extent of invasiveness (stage) rather than a different histogenesis. Further investigations are needed. However, from a practical point of view, efforts should be made to excise this group of tumors with clear margins, as margin status appears to be the most important prognostic factor regardless of the presence or absence of epithelial differentiation.
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31
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Lewis RB, Mehrotra AK, Rodriguez P, Levine MS. From the radiologic pathology archives: esophageal neoplasms: radiologic-pathologic correlation. Radiographics 2014; 33:1083-108. [PMID: 23842973 DOI: 10.1148/rg.334135027] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Esophageal neoplasms have a wide spectrum of clinical features, pathologic findings, and imaging manifestations. Leiomyomas are the most common benign esophageal neoplasm, typically appearing as smoothly marginated intramural masses. Fibrovascular polyps arise in the cervical esophagus, gradually elongating as they are pulled inferiorly by esophageal peristalsis. Granular cell tumors are generally incidental small intramural masses with an appearance similar to that of leiomyomas. Malignant esophageal neoplasms are a common cause of cancer mortality, particularly squamous cell carcinoma (SCC) and adenocarcinoma. Both of these tumors occur in older men, most often appearing as irregular infiltrative lesions at barium examination, with evidence of tumor spread beyond the esophagus at cross-sectional imaging. Adenocarcinoma arises from Barrett esophagus and is much more likely than SCC to involve the gastroesophageal junction. Esophageal involvement by lymphoma is usually secondary to tumor spread from the stomach or mediastinum. Spindle cell carcinoma is a biphasic malignancy with carcinomatous and sarcomatous elements that forms a bulky polypoid intraluminal mass. Neuroendocrine carcinoma is an aggressive neoplasm that may be hypervascular and is usually associated with metastatic disease at presentation. Understanding the imaging appearances and pathologic bases of esophageal neoplasms is essential for their detection, differential diagnosis, staging, and treatment planning.
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Affiliation(s)
- Rachel B Lewis
- American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910, USA.
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32
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Dhungel BM, De Petris G. Bizarre stromal cells in the esophagus: report of 2 cases and literature review. Int J Surg Pathol 2013; 21:368-72. [PMID: 23714685 DOI: 10.1177/1066896913489347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A significant mimicker of malignancy in the esophagus is the presence of atypical/bizarre stromal cells (BSCs). Two patients, a 60-year-old woman and a 59-year-old man, with esophageal polyps at the gastroesophageal junction showed highly atypical/bizarre cells in the polyps' stroma. BSCs were admixed with inflammatory cells and had large atypical nuclei, prominent nucleoli, and variably abundant amphophilic cytoplasm. Immunohistochemical studies showed that BSCs expressed vimentin whereas S-100, CD68, HMB45, CD45, Pan-cytokeratin, CK5/6, p63, CD10, EMA, MART-1, desmin, smooth muscle actin, CD31, CD34, and CMV were negative. Ki-67 showed low proliferative rate (less than 1% positivity). No evidence of intracellular mucin was found after histochemical stains (AB/PAS and mucicarmine). Follow-up endoscopic mucosal resection was available in both cases and showed benign esophageal mucosa and submucosa with disappearance, in one case, or marked decrease of BSCs. Esophageal BSCs reports in the literature invariably locate them in distal esophagus polyps or masses. Awareness of BSCs, of their location and associations, may help to prevent misdiagnosis of malignancy. The literature of esophageal BSCs is reviewed and the approach to this abnormality is discussed.
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Affiliation(s)
- Bal M Dhungel
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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33
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Sung CO, Choi H, Lee KW, Kim SH. Sarcomatoid carcinoma represents a complete phenotype with various pathways of epithelial mesenchymal transition. J Clin Pathol 2013; 66:601-6. [PMID: 23533257 DOI: 10.1136/jclinpath-2012-201271] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Sarcomatoid carcinoma (SC) is considered to be a result of the sarcomatoid change of epithelial carcinoma. However, epithelial-mesenchymal transition (EMT) in SC has been insufficiently studied. METHODS We evaluated the expression patterns of EMT-related phenotypic markers with transcription factors in 27 SCs originating from various organs, and we investigated the phenotypic characteristics of SCs classified as complete, incomplete or wild-type. We further analysed correlations between EMT-related phenotype markers and transcription factors. RESULTS Epithelial markers (E-cadherin, claudin-3 and claudin-4) were consistently down-regulated, whereas mesenchymal markers (S100A4, α-smooth muscle actin (SMA), vimentin, PDGFRα and β-catenin) were variously expressed except for vimentin. EMT-related transcription factors (SIP1, Snail1, Slug, Twist1, ZEP1 and Oct-4) also showed various expression patterns. The expression patterns of phenotypic markers showed that most SCs (22/27, 81.5%, 95% CI 65.8 to 97.1%) had complete EMT phenotypes, whereas the remaining 5 (18.5%, 95% CI 2.8 to 24.1%) were of incomplete type. Unsupervised hierarchical clustering analysis revealed that SCs were clustered into several subgroups by EMT-related protein expression pattern. Twist1 positivity was significantly concordant with α-SMA positivity (κ value: 0.908; 95% CI 0.73 to 1.00, p<0.001, adjusted p<0.001). The EMT phenotypes of SC were simple, with complete phenotype being the predominant form, and the morphological changes of the SCs were also relevant in terms of EMT. CONCLUSIONS SC seems to be an irreversible, permanent change in the EMT phenomenon, with complete EMT phenotypes and various EMT-related pathways being involved in SC.
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Affiliation(s)
- Chang Ohk Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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34
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Lee SE, Park SY. Sarcomatoid carcinoma of the small intestine: a rare and highly aggressive tumor. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:321-4. [PMID: 23166892 PMCID: PMC3491235 DOI: 10.4174/jkss.2012.83.5.321] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/29/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
Abstract
Sarcomatoid carcinoma of the small intestine is an extremely rare malignant neoplasm that usually has a poor prognosis. We report a case of sarcomatoid carcinoma arising in the small intestine in a 62-year-old man who was hospitalized for abdominal pain. Computed tomography revealed wall thickening of the small intestine. The resected specimen showed a gray-whitish solid mass with hemorrhage and necrosis. Microscopically, the tumor was composed of pleomorphic spindle and discohesive polygonal cells with frequent mitosis. No carcinomatous component was recognized. Immunohistochemistry revealed coexpression of cytokeratin and vimentin by the tumor cells, whereas expressions of C-kit, CD34, HMB-45, smooth muscle actin, and desmin were negative. The diagnosis was sarcomatoid carcinoma of the small intestine.
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Affiliation(s)
- Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
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