Rapid-Growing Carcinosarcoma of the Esophagus Arising from Intraepithelial Squamous Cell Carcinoma: Report of a Case

Abstract

A case of carcinosarcoma arising from the intraepithelial spreading area of esophageal squamous cell carcinoma (SCC) is reported herein. A 64-year-old man was referred to our hospital for investigation of a sore throat and dysphagia. An endoscopic examination revealed a 2. 5-cm polypoid mass in the mid-esophagus. Esophagograms taken 1 month prior to consultation by our hospital and just before surgery revealed marked change within a period of less than 2 months from a 2-cm sessile elevated mass to a 4-cm polypoid mass with a lobular appearance. The resected specimen contained two lesions in the esophagus. The larger one measured 4.0 x 2.0 x 2.0 cm and had a pedunculated polypoid shape, while the smaller one, measuring 1 cm in diameter, was a plateau-type elevated lesion located 3 cm distal from the larger mass. Histologically, the distal smaller lesion was diagnosed as primary SCC associated with a high frequency of intraepithelial spread, while the larger polypoid mass was composed of spindle-shaped sarcomatous cells, arising from the intraepithelial spread of SCC. To our knowledge, this is the only reported case of esophageal carcinosarcoma arising from an area of intraepithelial spread of SCC that showed such surprisingly rapid growth.

A Case of Metachronous Development of Esophageal Squamous Cell Carcinoma in the Patient with Esophageal Carcinosarcoma

“…There have been several case reports on synchronous carcinosarcoma and squamous cell carcinoma in the esophagus, [3][4][5] and a case report of esophageal carcinosarcoma arising from squamous cell carcinoma after chemoradiation. 6 In a study with Taiwanese patients, Kuo et al 7 reported that approximately 33% (4/12) of carcinosarcoma had previous head and neck squamous cell carcinoma that occurred metachronously.…”

“…1,3 In a study with 20 cases of esophageal carcinosarcoma, Iyomasa et al 1 reported that recurrence due to hematogenous metastasis was more frequent in esophageal carcinosarcoma than esophageal squamous cell carcinoma. They emphasized that radical resection with lymph node dissection was necessary for treatment of carcinosarcoma regardless of the depth of invasion.…”

Rapid-growth carcinosarcoma of the esophagus arising from 0-IIc squamous cell carcinoma after definitive chemoradiotherapy: a case report

“…In addition, rapid growth of this tumor has been clinically observed. Sasajima et al and Uchiyama et al reported the doubling time of this tumor to be 2.2 months and 55 days, respectively [6,7]. We recently encountered a unique case of esophageal carcinosarcoma arising from an area of intraepithelial spread of relapsed SCC after defi nitive chemoradiotherapy (CRT).…”

Extensive and divergent chromosomal losses in squamous and spindle-cell components of esophageal sarcomatoid carcinoma

“…Using light microscopy, a gradual transition between the carcinomatous and sarcomatous components has been observed in a majority of cases [6]. Immunohistochemical [7,13,24,30] and electron microscopic [7,24,25] studies indicated that the SA component carried various degrees of epithelial differentiation. Limited genetic studies on sarcomatoid carcinomas have also found that the same genetic alterations are commonly shared in the SCC and SA components in the uterus, breast, lung, gastrointestinal tract, urinary bladder, pharynx, and the upper respiratory tract [1,3,28,29].…”