Expression of receptor tyrosine kinases in esophageal carcinosarcoma

The controversy of esophageal carcinosarcoma: A case report and brief review of literature

RATIONALE

Esophageal carcinosarcoma (ECS) is defined as a relatively rare malignant neoplasm with both epithelial carcinomatous and sarcomatous components. Besides, there were so many various controversies in ECS. This article describes a case of ECS that was effectively treated with radical esophagectomy and adjuvant chemotherapy. Also, we discuss the presentation, differential diagnosis, treatment, and prognosis of ECS.

PATIENT CONCERNS

A 58-year-old man presented with a history of progressive dysphagia and precordial pain after swallowing for 1 month.

DIAGNOSIS

Esophagogastroduodenoscopy (EGD) revealed a large polypoid neoplasm that occupied the esophageal lumen 30 to 34 cm from the incisors. On the characteristic morphology, clinical symptom and biopsy findings, the ECS was the primary considerated. Computed tomography (CT) examination demonstrated no radiological evidence of metastatic disease.

INTERVENTIONS

The patient underwent an Ivor Lewis esophagectomy, coupled with adequate lymph node dissection (2-field lymphadenectomy). ECS was confirmed by pathology report of postoperative. Then, the patient underwent adjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine.

OUTCOMES

The patient remained alive without tumor recurrence at 24 months after multidisciplinary therapy.

LESSONS

It is generally treated by surgery, radiotherapy, and chemotherapy according to the protocols used for other esophageal cancers (EC). However, there is no recommended clinical treatment for ECS because of the rarity of the disease. Esophagectomy with extended lymphadenectomy followed by adjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine may be recommended treatment for ECS. Chemotherapy regimen with docetaxel, oxaliplatin, and capecitabine may be a suitable adjuvant therapy for ECS.

Clinicopathological features of esophageal carcinosarcoma in Xinjiang

AIM: To explore the clinicopathological characteristics of and diagnostic criteria for carcinosarcoma of the esophagus.

METHODS: The clinical features, histologic and immunohistochemical findings, and the result of fluorescence in situ hybridization in five cases of esophageal carcinosarcoma were analyzed. A review of the literature was also performed.

RESULTS: Among the five cases, four were male (4 vs 1). There were 3 Han patients, and the other two cases were Uighur and Kazak, respectively. Macroscopically, the tumor was usually located at the lower part of the esophagus with a polyp-like appearance. The tumor size varied, with the largest diameter being 5 cm. Microscopically, the pattern of carcinoma and sarcoma might be separately distributed or mixed with each other as well. All of the 5 cases in the current study were squamous carcinoma mixed with fibrosarcoma. Immunohistochemically, the carcinomatous pattern was positive for cytokeratin (CK) CK5/6 and p63, and negative for Vimetin; the sarcoma pattern was positive for Vimetin, and negative for CK, CK5/6 and p63. There was no overlap expression for the markers of interest between the carcinoma region and sarcoma region. In situ hybridization analysis showed negative EBER expression.

CONCLUSION: Esophageal carcinosarcoma is a less aggressive malignant tumor composed of two elements (carcinoma and sarcoma). The entity needs to be distinguished from sarcomatoid carcinoma, squamous cell carcinoma, undifferentiated sarcoma and inflammatory pseudotumor.