Expression of receptor tyrosine kinases in esophageal carcinosarcoma

Multiregion exome sequencing indicates a monoclonal origin of esophageal spindle-cell squamous cell carcinoma

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.

Clinicopathologic features and surgical treatment prognosis of esophageal carcinosarcoma

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.

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.