Carcinosarcoma of the esophagus characterized by myoepithelial and ductal differentiations

Abstract

We report a case of carcinosarcoma of the esophagus characterized by ductal and myoepithelial differentiation. A 61-year-old man was operated on for a polypoid tumor of the distal esophagus. Histologically, this tumor was composed of ductal structures and sarcomatous spindle cells surrounding the ducts at the central area of the tumor. The tumor was also composed of squamous cell and basaloid carcinoma in the periphery. Immunohistochemically, a few spindle cells surrounding the ductal structures showed immunopositivity for alpha-smooth muscle actin and S-100 protein. Electron microscopy revealed that the spindle cells had tonofilament and pinocytic vesicles in the cytoplasm, and basal lamina adjacent to the cytoplasmic membrane. Both of the results strongly supported the suggestion that the spindle cells may be myoepithelial cells. Basaloid carcinoma showed a gradual transition to chondrosarcomatous cells producing the matrix, which had both immunopositivities for S-100 protein and cytokeratin. Therefore, chondrosarcomatous cells may be derived from carcinoma cells. The histogenesis of this tumor may be associated with a totipotent stem cell of esophageal mucosa, which has the potential to differentiate into squamous cells, ductal cells or myoepithelial cells.

Diagnosis of primary esophageal synovial sarcoma by demonstration of t(X;18) translocation: a case report

“…Dysphagia was the most frequent complaint [1-5, 7, 17, 18]. Radiologically, an intraluminal mass into esophagus was present in all cases, involving the cervical or proximal esophagus (seven cases) [1,2,4,5,8,15,16] or the gastroesophageal junction (one case) [3]. Macroscopically, the tumors ranged from 4.5 to 21 cm in size and were mostly solid, polypoid, without or with few areas of necrosis and hemorrhage [1-5, 7, 17, 18].…”

“…However, these different criteria for diagnosis are not specific of SS and can be demonstrated in other malignant tumors. Particularly in the esophageal location, these different features can be observed both in SS and in sarcomatoid carcinoma (carcinosarcoma) [3,11,13,16]. The recognition of SS in this unexpected site is probably often mistaken.…”

Esophageal carcinoma originating in the surface epithelium with immunohistochemically proven esophageal gland duct differentiation: A case report

“…In the cited case, the outer layer cells of the neoplastic tubules had clear cytoplasm and expressed SMA, similar to the outer layer cells seen in adenomyoepithelioma of the breast or epithelial-myoepithelial carcinoma of the salivary gland. The tumor reported by Ohtaka et al[11] was an esophageal carcinosarcoma in which the neoplastic ducts were surrounded by neoplastic myoepithelial cells. These cases suggest that the tubular components of the carcinomas differentiated towards the intralobular ducts of the esophageal gland.…”

Primary Mixed Squamous Carcinoma and Osteosarcoma (Carcinosarcomas) of the Lung Have a CGH Mapping Similar to Primitive Squamous Carcinomas and Osteosarcomas

“…Because both components are mixed in all published cases, it is more reasonable to accept the monoclonal hypothesis attributing the origin of CSs to a single totipotent stem cell. 18 The publication of CSs of small size, less than 1 cm in maximum diameter, suggests that the sarcomatoid transition could take place relatively early. 19 The absence of discrete limits to each component of the tumor strengthens the premature differentiation to epithelial and mesenchymal neoplastic cells.…”