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Miyauchi J, Ogura M, Sato M, Matsui J. Esophageal carcinosarcoma comprised of minimally invasive squamous cell carcinoma and undifferentiated pleomorphic sarcoma: A collision cancer? Pathol Int 2018; 68:479-484. [PMID: 29934989 DOI: 10.1111/pin.12689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/27/2018] [Indexed: 02/28/2024]
Abstract
Esophageal carcinosarcoma is a rare neoplasm with components of squamous cell carcinoma and sarcomatous spindle cell stroma. The latter may show overt mesenchymal differentiation but is thought to be derived from carcinoma cells in most cases. Here, we report a case of esophageal carcinosarcoma that appeared to be comprised of different origins of epithelial and mesenchymal tumor cells. The sarcomatous component formed an intralumial pedunculated large mass lesion that consisted of pleomorphic atypical histiocyte-like cells. The squamous epithelium exhibited features of mostly dysplasia with minor foci of microinvasive squamous cell carcinoma. The invasive carcinoma was apart from the sarcoma, and no transitions were observed between the epithelial and sarcomatous cells. Immunohistochemistry showed that the sarcoma cells did not express any lineage-specific markers, including those for epithelial cells and histiocytes, which lead to the diagnosis of undifferentiated pleomorphic sarcoma. Although cyclin D1 was overexpressed in the carcinoma cells, it was nearly negative in the sarcoma cells. These findings indicate that the tumor may be a collision carcinosarcoma. It is highly likely that the patient's history of heavy smoking and alcohol consumption were relevant to the pathogenesis, at least for the epithelial component, of the tumor.
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Affiliation(s)
- Jun Miyauchi
- Department of Pathology & Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba-ken, Japan
| | - Masaharu Ogura
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba-ken, Japan
| | - Michio Sato
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba-ken, Japan
| | - Junichi Matsui
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba-ken, Japan
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Zhang B, Xiao Q, Yang D, Li X, Hu J, Wang Y, Wang W. Spindle cell carcinoma of the esophagus: A multicenter analysis in comparison with typical squamous cell carcinoma. Medicine (Baltimore) 2016; 95:e4768. [PMID: 27631227 PMCID: PMC5402570 DOI: 10.1097/md.0000000000004768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study conducted a retrospective multicenter analysis to investigate the clinicopathological features, optimal therapeutic strategy, and prognosis of spindle cell carcinoma (SpCC) of the esophagus.A total of 71 patients with esophageal SpCC from 3 large cancer centers in China were systematically analyzed. All patients received curative resection, 13 patients received adjuvant radiotherapy and 15 patients received adjuvant combination chemotherapy. Additionally, a total of 1852 patients with typical esophageal SCC (SCC) were selected as controls in this study.SpCC mostly presented as a polypoid appearance (66.2%), and the surrounding mucosa showed high-grade hyperplasia or superficial SCC in 31 cases (43.7%). Two patients even had extensive carcinoma in situ that spread to the resection margins. Patients in the SpCC group were more likely to present with stage I lesions compared with those in the typical SCC group (33.8% vs 8.0%, P < 0.001). Although the percentage of T1/2 lesions was higher in the SpCC group than in the typical SCC group (67.6% vs 29.7%, P < 0.001), both groups had similar rates of locoregional lymphatic metastases (45.1% vs 48.4%, P = 0.578). The median survival time and 5-year overall survival of the SpCC group was 43 months and 44.8%, respectively, higher than 37.5 months and 38.3%, respectively, for the typical SCC group (P = 0.044). In univariate analysis, the macroscopical type and pathological T, N, and TNM stages had a statistically significant impact on the prognosis of SpCC after curative resection. However, only the TNM stage (hazard ratio, 2.708; 95% confidence interval, 1.786-4.105, P < 0.001) was identified as an independent prognostic factor in multivariate analysis. The 5-year OS of SpCC in stages I (79.8%) and II (39.7%) were significantly longer than that of stages III/IV (16.2%) (P < 0.001 and P = 0.012). As those SpCC cases that received chemoradiotherapy were in more advanced stages, their prognosis was still worse than SpCC patients who did not receive chemoradiotherapy even after such treatment (P = 0.042, 0.010, respectively).SpCC shows a highly aggressive tendency of lymphatic spread, although it does not tend to infiltrate deeply into the esophageal wall. Compared with typical SCC that also underwent esophagectomy with extended lymphadenectomy, SpCC may achieve a better survival rate. Further investigation is warranted to examine the effect of postoperative chemoradiotherapy on the prognosis of SpCC.
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Affiliation(s)
| | - Qin Xiao
- The Department of Thoracic Radiotherapy
| | | | - Xu Li
- The 2nd Department of Thoracic Surgery
| | - Jun Hu
- The Department of Pathology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, CSU, Changsha, Hunan Province
| | - Yonggang Wang
- Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, BeijingThe People's Republic of China
- Correspondence: Yonggang Wang, Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, The People's Republic of China (e-mail: ); Wenxiang Wang, The 2nd Department of thoracic surgery, Hunan Cancer Hospital, Yuelu District, Changsha, China (e-mail: )
| | - Wenxiang Wang
- The 2nd Department of Thoracic Surgery
- Correspondence: Yonggang Wang, Department of Thoracic Surgery, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, The People's Republic of China (e-mail: ); Wenxiang Wang, The 2nd Department of thoracic surgery, Hunan Cancer Hospital, Yuelu District, Changsha, China (e-mail: )
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Nakazawa T, Nobusawa S, Ikota H, Kuwano H, Takeyoshi I, Yokoo H. Wide expression of ZEB1 in sarcomatous component of spindle cell carcinoma of the esophagus. Pathol Int 2015; 65:635-43. [PMID: 26515382 DOI: 10.1111/pin.12354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/26/2015] [Indexed: 12/15/2022]
Abstract
The pathogenesis of sarcomatous component in spindle cell carcinoma (SpCC) of the esophagus is unclear. To investigate the involvement of epithelial-mesenchymal transition (EMT) in sarcomatous differentiation, we performed immunohistochemistry for Slug, Twist, ZEB1, and ZEB2, transcription factors associated with EMT and E-cadherin, in 14 cases of SpCC of the esophagus. In order to verify the neoplastic nature of sarcomatous components, TP53 mutation status and protein expression were examined in each case. Nuclear ZEB1 expression was extensive in the sarcomatous component, greater than invasive front of carcinoma components (P < 0.0001). Membranous E-cadherin expression was mostly lost in sarcomatous cells in all cases (P < 0.0001). The p53 expression pattern was almost concordant between the two areas in all cases. TP53 mutation analysis revealed that seven cases harbored identical mutations in both components. One case had mutations only in the sarcomatous component. It is noteworthy that none of them harbored mutation in exon 5, unlike conventional esophageal squamous cell carcinoma. These findings show that ZEB1 are widely expressed in the sarcomatous area of SpCC of the esophagus, suggesting the involvement of EMT. The avoidance of exon 5 in terms of TP53 mutation may also be a feature of the tumor.
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Affiliation(s)
- Takuro Nakazawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hayato Ikota
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Izumi Takeyoshi
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Singhi AD, Seethala RR, Nason K, Foxwell TJ, Roche RL, McGrath KM, Levy RM, Luketich JD, Davison JM. Undifferentiated carcinoma of the esophagus: a clinicopathological study of 16 cases. Hum Pathol 2014; 46:366-75. [PMID: 25582499 DOI: 10.1016/j.humpath.2014.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 12/20/2022]
Abstract
Undifferentiated carcinoma of the esophagus is a rare histologic variant of esophageal carcinoma. Using criteria based on studies of undifferentiated carcinomas arising at other sites, we have collected 16 cases of resected esophageal undifferentiated carcinomas. Patients ranged in age from 39 to 84 years (mean, 65.5 years) and were predominantly male (94%). The tumors were characterized by an expansile growth pattern of neoplastic cells organized in solid sheets and without significant glandular, squamous, or neuroendocrine differentiation. The neoplastic cells had a syncytial-like appearance, little intervening stroma, and patchy tumor necrosis. In a subset of cases, the tumor cells adopted a sarcomatoid (n = 2), rhabdoid (n = 1), or minor component (<5%) of glandular morphology (n = 3). In 1 case, reactive osteoclast-like giant cells were found interspersed among the neoplastic cells. Lymphovascular invasion, perineural invasion, and lymph node metastases were identified in 88%, 56%, and 81% of cases, respectively. In 12 (75%) specimens, the background esophageal mucosa was notable for Barrett esophagus. Consistent with the epithelial nature of these neoplasms, cytokeratin positivity was identified in all cases. In addition, SALL4 expression was present in 8 (67%) of 12 cases. Follow-up information was available for 15 (94%) of 16 patients, all of whom were deceased. Survival after surgery ranged from 1 to 50 months (mean, 11.9 months). Before death, 67% patients had documented locoregional recurrence and/or distant organ metastases. In summary, esophageal undifferentiated carcinomas are aggressive neoplasms and associated with a high incidence of recurrence and/or metastases and a dismal prognosis.
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Affiliation(s)
- Aatur D Singhi
- Department of Pathology, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213.
| | - Raja R Seethala
- Department of Pathology, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - Katie Nason
- Department of Surgery, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - Tyler J Foxwell
- Department of Pathology, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - Robyn L Roche
- Department of Pathology, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - Kevin M McGrath
- Department of Medicine, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - Ryan M Levy
- Department of Surgery, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - James D Luketich
- Department of Surgery, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - Jon M Davison
- Department of Pathology, the University of Pittsburgh Medical Center, Pittsburgh, PA 15213
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Esophageal carcinosarcoma presenting as a fever with elevated serum interleukin-6. Ann Thorac Surg 2011; 91:1288-90. [PMID: 21440168 DOI: 10.1016/j.athoracsur.2010.09.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/31/2010] [Accepted: 09/27/2010] [Indexed: 11/23/2022]
Abstract
We report a patient with esophageal carcinosarcoma who initially presented with fever. A 57-year-old man with a 4-month history of intermittent fever was referred to our hospital and diagnosed as having esophageal carcinosarcoma. High fever persisted and serum concentration of interleukin-6 was markedly elevated. In contrast, after thoracic esophagectomy, the fever subsided and interleukin-6 serum levels rapidly normalized. The clinical course of the patient suggests that the tumor produced interleukin-6 and this was associated not only with inflammation, but also the aggressive biologic behavior of the tumor.
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Kuo CJ, Lin TN, Lin CJ, Wu RC, Chang HK, Chu YY, Lien JM, Su MY, Chiu CT. Clinical manifestation of esophageal carcinosarcoma: a Taiwan experience. Dis Esophagus 2010; 23:122-7. [PMID: 19473206 DOI: 10.1111/j.1442-2050.2009.00976.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Carcinosarcoma of the esophagus is a rare neoplasm with both carcinomatous and sarcomatous components. This study aimed to investigate its clinicopathologic features and endoscopic characteristics. The data of patients diagnosed to have esophageal carcinosarcoma pathologically in the past 30 years (January 1976-December 2007) were reviewed. Of 3318 cases of esophageal malignancy, 12 were diagnosed as esophageal carcinosarcoma, with an incidence of 0.36%. All of the cases were male with a mean age of 62.3 years. Of the 12 tumors, 8 were polypoid type, and 4 were ulcerative type. In the endoscopic ultrasonography examination, the tumors show heterogeneous hypoechoic lesions with irregular outer margins and internal multicystic components. Four patients (33.3%) had previous head and neck squamous cell carcinoma that occurred metachronously. This is the first report about the characteristics of esophageal carcinosarcoma under endoscopic ultrasonography examination. The relationship between esophageal carcinosarcomas and head and neck cancer needs further investigation.
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Affiliation(s)
- C-J Kuo
- Departments of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, 5, Fushin Street, Kweishan, Taoyuan, Taiwan
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Yanamoto S, Kawasaki G, Yoshida H, Yoshitomi I, Iwamoto T, Mizuno A, Fujita S. Rapidly growing mass of the anterior maxillary gingiva. ACTA ACUST UNITED AC 2007; 104:153-9. [PMID: 17449292 DOI: 10.1016/j.tripleo.2006.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 12/01/2006] [Accepted: 12/11/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Souichi Yanamoto
- Department of Oral and Maxillofacial Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Rizzardi C, Frezzini C, Maglione M, Tirelli G, Melato M. A look at the biology of spindle cell squamous carcinoma of the oral cavity: report of a case. J Oral Maxillofac Surg 2003; 61:264-8. [PMID: 12619009 DOI: 10.1053/joms.2003.50025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clara Rizzardi
- Unit of Pathology, University of Trieste, Trieste, Italy
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Handra-Luca A, Terris B, Couvelard A, Molas G, Degott C, Flejou JF. Spindle cell squamous carcinoma of the oesophagus: an analysis of 17 cases, with new immunohistochemical evidence for a clonal origin. Histopathology 2001; 39:125-32. [PMID: 11493328 DOI: 10.1046/j.1365-2559.2001.01174.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To study the morphological and immunohistochemical characteristics of spindle cell squamous carcinoma of the oesophagus, in order better to understand the histogenesis of this tumour. METHODS AND RESULTS In this study we analysed the morphological and immunohistochemical characteristics of 17 cases of spindle cell squamous carcinoma of the oesophagus. Most tumours were polypoid, but tumours with an ulcerated and infiltrative pattern were also observed. Histologically, most tumours were of superficial type, with a characteristic morphological aspect consisting of two types of tumour cells, i.e. differentiated squamous cells, and spindle cells with transition zones between the two components. On immunohistochemistry, the squamous cells were positive for cytokeratin and the spindle cells showed variable expression of cytokeratin, vimentin and smooth muscle actin. p53 protein was over-expressed in 10 cases, both tumour cell types showing strong nuclear positivity. In most tumours, E-cadherin was expressed in the squamous cells and absent in the spindle cells. CONCLUSIONS The similar pattern of p53 protein expression in the two tumour cell types of spindle cell squamous carcinoma of the oesophagus suggests their common origin. The change in adhesion molecule expression with loss of E-cadherin expression may be associated with the acquisition of spindle cell morphology by the squamous tumour cells.
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Affiliation(s)
- A Handra-Luca
- Department of Pathology, Beaujon Hospital, Clichy, France
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