Spindle cell squamous carcinoma of the esophagus: Analysis of ploidy and tumor proliferative activity in a series of 13 cases

Lauwers, Gregory Y.; Grant, Lawrence D; Scott, Gregory V.; Carr, Norman J.; Sobin, Leslie H.

doi:10.1016/s0046-8177(98)90458-0

Cited by 26 publications

(27 citation statements)

References 17 publications

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“…First, a definite diagnosis of SpCC could be hardly made before treatment (14.1%), whereas surgery could help make a definitive diagnosis and provide a chance for cure. Second, locoregional lymphatic metastases were detected in 45.1% of SpCC patients, consistent with the rate of 33% to 65% in former studies, [1,2,7,9,11,14,19,20] suggesting the highly aggressive behavior of the disease. Thus, 2- or 3-field lymphadenectomy should be performed to improve the surgical radicality in esophageal SpCC.…”

Section: Discussionsupporting

confidence: 88%

“…[1–3] Although SpCC is biphasic in cellular pleomorphism, it is now believed to be of monoclonal epithelial origin, with a sarcomatoid differentiation. [1–7] However, the heterogeneous morphological structure of SpCC has presented significant diagnostic challenges and led to a confounding list of names, including carcinosarcoma, sarcomatoid carcinoma, pseudosarcoma, polypoid carcinoma, and spindle cell carcinoma. [2,8] Characteristically, SpCC presents as a bulky pedunculated mass with a spindle cell component in the stroma and a squamous cell component on the surface, and the latter component may be invasive carcinoma, carcinoma in situ, or dysplasia.…”

Section: Introductionmentioning

confidence: 99%

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Spindle cell carcinoma of the esophagus

Zhang¹,

Xiao²,

Yang³

et al. 2016

Medicine

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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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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Spindle cell carcinoma of the esophagus

Zhang¹,

Xiao²,

Yang³

et al. 2016

Medicine

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“…For instance, the solid growth pattern of neoplastic cells can resemble a poorly differentiated, nonkeratinizing squamous cell carcinoma or a high-grade neuroendocrine carcinoma of the esophagus [29]. Two undifferentiated carcinomas within our series adopted a sarcomatoid appearance that could mimic an esophageal spindle cell squamous carcinoma [30]. Moreover, rhabdoid foci present within undifferentiated carcinomas may raise the consideration for melanoma, lymphoma, or a rhabdoid carcinoma of the gastrointestinal tract [31].…”

Section: Discussionmentioning

confidence: 99%

Undifferentiated carcinoma of the esophagus: a clinicopathological study of 16 cases

et al. 2015

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Summary 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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“…Based on the results of DNA flow analysis, it is of interest that the sarcomatous components were aneuploid with one exception, while the carcinomatous components were diploid in all cases. Lauwers et al [12]reported that the sarcoma-like areas were aneuploid in all 13 cases. Therefore, it appears that the sarcomatous elements are phenotypically more malignant and are more likely to determine the malignant behavior of esophageal carcinosarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…The sarcomatous elements of the so-called carcinosarcoma are thought to consist of spindle-shaped, transformed epithelial cells. With regard to DNA ploidy in carcinosarcoma of the esophagus, sarcoma-like areas were aneuploid in only one report [12]. …”

Section: Introductionmentioning

confidence: 99%

So-Called Carcinosarcoma of the Esophagus: A Clinicopathologic, Immunohistochemical and DNA Flow-Cytometric Analysis of 6 Cases

Natsugoe¹,

Matsushita

Chuman³

et al. 1999

Oncology

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Six cases of carcinosarcoma of the esophagus were studied clinicopathologically, immunohistochemically and with DNA flow cytometry. Transitional areas with morphology intermediate between carcinoma and sarcoma were found microscopically in all cases. Immunohistochemically, the carcinomatous areas contained keratin-positive cell components in all cases while vimentin-positive cells were found in sarcomatous areas in 5 cases. By DNA flow analysis of microdissection, the sarcomatous components of the tumors showed an aneuploid pattern with one exception, in contrast the carcinomatous components were diploid in all cases. In these few cases, PCNA, S-phase fraction and the mitotic rate were extremely high, apparently indicating a correlation with malignant behavior. Accordingly, examination by immunohistochemistry and DNA ploidy is useful for the analysis of biological properties in the so-called carcinosarcoma of the esophagus.

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Spindle cell squamous carcinoma of the esophagus: Analysis of ploidy and tumor proliferative activity in a series of 13 cases

Cited by 26 publications

References 17 publications

Spindle cell carcinoma of the esophagus

Spindle cell carcinoma of the esophagus

Undifferentiated carcinoma of the esophagus: a clinicopathological study of 16 cases

So-Called Carcinosarcoma of the Esophagus: A Clinicopathologic, Immunohistochemical and DNA Flow-Cytometric Analysis of 6 Cases

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