Multiple carcinosarcomas of the esophagus with adeno-carcinomatous components: A case report
Multiple carcinosarcomas of the esophagus with adeno-carcinomatous components: A case report
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DOI：
10.3748/wjg.v26.i17.2111
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发表时间：
2020-05-07
影响因子：
4.3
通讯作者：
Kamei, Takashi
中科院分区：
文献类型：
--
作者：
Okamoto, Hiroshi;Kikuchi, Hiroshi;Kamei, Takashi
食管癌肉瘤（梭形细胞癌）是一种非常罕见的疾病，其病因和起源尚未确定。上皮间质转化（EMT）已与侵袭和转移，并可能与生成的干细胞群体内this tumor.CASE概要我们提出的情况下，一个61岁的男性恶心和发烧。上消化道内窥镜检查显示存在1型和0-IIc型病变，位于距门牙35 cm处的食管-胃交界处。行胸腔镜食管切除术。肉眼分析显示，腹部食管中有3处息肉样病变，伴随胸下段食管中的主要病变，0-IIc病变随其持续扩散。组织学上，病变包括增殖的梭形细胞。在足部附近的切片中检测到腺癌成分，在肿瘤基底部的粘膜中发现鳞状细胞癌。患者被诊断为多发性癌细胞瘤，分期为pT 1b（SM 3）、pN 1（#110、#7）、cM 0、II期（肉瘤转移至淋巴结）。梭形细胞不表达E-cadherin，但EMT标记阳性，包括锌指E盒结合同源框1，TWIST和蜗牛家族转录抑制因子2。该患者术后5年2个月无复发。结论本报告提示原发性鳞状细胞癌可能通过EMT相关机制产生多发性肉瘤性肿瘤。
BACKGROUND Carcinosarcoma (spindle cell carcinoma) of the esophagus is an extremely rare event; the etiology and origins of this neoplasm have not yet been determined. Epithelial-mesenchymal transition (EMT) has been associated with invasion and metastasis, and may be related to the generation of a stem cell population within this tumor.CASE SUMMARY We present the case of a 61-year-old male with nausea and fever. Upper gastrointestinal endoscopy revealed the presence of type 1 and 0-IIc lesions located 35 cm from the incisors toward the esophago-gastric junction. Thoracoscopic esophagectomy was performed. Macroscopic analysis revealed three polypoid lesions in the abdominal esophagus that accompanied the main lesion in the lower thoracic esophagus and 0-IIc lesions that spread continuously with them. Histologically, the lesions included proliferating spindle cells. Adeno-carcinomatous components were detected in a section near the foot, and squamous cell carcinoma was identified in the mucosa at the base of the tumor. The patient was diagnosed with multiple carcinosarcomas, staged at pT1b (SM3), pN1 (#110, #7), cM0, Stage II (sarcomatous metastasis to the lymph nodes). Spindle cells did not express E-cadherin but were positive for EMT markers, including zinc finger E-box-binding homeobox 1, TWIST, and snail family transcriptional repressor 2. The patient has experienced no recurrence at 5 years and 2 mo after surgery.CONCLUSION This report suggests that multiple sarcomatous tumors may be generated from primary squamous cell carcinoma via mechanisms related to EMT.