Esophageal Carcinosarcoma with Basaloid Squamous Cell Carcinoma: A Case Report and Review of the Literature

Ishida, Hirotaka; Fujishima, Fumiyoshi; Onodera, Yu; Konno-Kumagai, Takuro; Maruyama, Shota; Okamoto, Hiroshi; Sato, Chiaki; Heishi, Takahiro; Sakurai, Tadashi; Taniyama, Yusuke; Kamei, Takashi; Sasano, Hironobu

doi:10.1620/tjem.249.255

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…However, untargeted endoscopic biopsies of this lesion usually reveal components of sarcoma, which makes it easily misdiagnosed. Efforts can be made to potentially improve the biopsy accuracy by targeting the root or peduncle as the epithelial cancer component always exceeds the mass in the range[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis of an elevated lesion in the esophagus: A case report

Ma¹,

Ma²,

Jia³

et al. 2022

WJCC

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BACKGROUND Esophageal carcinosarcoma (ECS) is a rare biphasic tumor and a type of esophageal malignancy, which presents as protruding or elevated lesions. ECS patients are often not hospitalized until they have severe dysphagia. ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy. With the popularization of endoscopic treatment, these patients are often referred to endoscopic treatment, such as endoscopic submucosal dissection (ESD). However, there is a lack of consensus on the endoscopic features and therapies for ECS. Here, we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies. CASE SUMMARY A 63-year-old man was admitted to the hospital with dysphagia. During the endoscopic examination, an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation. Endoscopic ultrasonography (EUS), biopsies, and enhanced thoracic computed tomography were performed, suggesting that it was a benign lesion and located within the submucosal layer. This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip. The patient was then referred to ESD treatment. However, the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin (T1b stage), indicating that we made a misdiagnosis and achieved a noncurative resection. Due to the potential tumor residue, additional open surgery was performed at the patient's request. In the postoperative pathological study, no tumor remnants or metastases were discovered. The patient was followed for 1 year and had no recurrence. CONCLUSION ECS can be misdiagnosed at the initial endoscopy. EUS can help to identify the tumor stage. Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Misdiagnosis of an elevated lesion in the esophagus: A case report

Ma¹,

Ma²,

Jia³

et al. 2022

WJCC

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“…The majority of esophageal carcinosarcomas presented as a bulky intraluminal polypoid mass and were located in the middle and lower esophagus[ 1 , 2 , 7 ]. Sarcomatoid components formed the body of the polypoid mass, and carcinomatous components (mostly squamous cell carcinoma) surrounded the base of the tumor, with a distinct transitional area between the two components[ 8 , 10 , 11 ]. The doubling time of esophageal carcinosarcoma was reported to be 2.2-5 mo, and the 5-year overall survival was 26.7%-61.9%[ 4 , 8 , 9 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic palliative resection of a giant 26-cm esophageal tumor: A case report

Li¹,

Guo²,

Ma³

et al. 2020

WJCC

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BACKGROUND Esophageal carcinosarcoma, usually presenting as a pedunculated polypoid mass, is a rare malignancy with coexisting sarcomatoid and carcinomatous components. Its imaging and endoscopic characteristics are similar to those of leiomyosarcoma, liposarcoma and so forth. The diagnosis needs histological confirmation. Surgical resection is the traditional therapy. Endoscopic resection is minimally invasive but still controversial. This paper reports the case of a patient with a giant esophageal carsinosarcoma who underwent a palliative endoscopic resection. CASE SUMMARY A 55-year-old male patient presented with dysphagia and weight loss for 1 mo. Imaging and endoscopy showed a gray-white, polypoid, stalk-like mass, with a bulky pedicle located in the middle and lower esophagus. The mass almost filled the whole esophageal lumen, but the endoscope could still pass through. Despite the suspicion of a malignancy, repeated biopsies indicated necrosis and inflammation. After multidisciplinary team consultation, an endoscopic resection to diagnose and relieve the obstruction was recommended. The pedicle of the mass was cut off, the bleeding was stopped, and the mass was cut into pieces and pulled out. The mass was 26 cm × 5 cm × 4 cm in size. The final diagnosis was esophageal carcinosarcoma. No postoperative complications occurred. After 1 mo, the patient gained 6 kg and endoscopic reexamination revealed no obstruction. Radical surgery with lymph node dissection was carried out successfully. This lesion was the largest endoscopically resected esophageal carcinosarcoma reported to date. CONCLUSION Endoscopic palliative resection can help obtain adequate tissue for diagnosis and relieve obstructions in patients with giant esophageal carcinosarcoma.

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“…Patients usually have symptoms of dysphagia at an early stage because ESC demonstrates a polypoid growth pattern and usually does not infiltrate deeply into the esophageal wall. Therefore, survival of patients with ESC is usually better than that of patients with SCC of the same size ( 64 ). However, Sano et al.…”

Section: Carcinosarcomamentioning

confidence: 99%

Rare malignant neoplasm of the esophagus: current status and future perspectives

Yoshinami,

Nishimura,

Hosokai

et al. 2023

Japanese Journal of Clinical Oncology

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Esophageal cancer is common worldwide, including in Japan, and its major histological subtype is squamous cell carcinoma. However, there are some rare esophageal cancers, including neuroendocrine neoplasm, gastrointestinal stromal tumor, carcinosarcoma and malignant melanoma. The biological and clinical features of these cancers differ from those of esophageal squamous cell carcinoma. Therefore, different treatment strategies are needed for these cancers but are based on limited evidence. Neuroendocrine neoplasm is mainly divided into neuroendocrine tumor and neuroendocrine carcinoma by differentiation and the Ki-67 proliferation index or mitotic index. Epidemiologically, the majority of esophageal neuroendocrine neoplasms are neuroendocrine carcinoma. The treatment of neuroendocrine carcinoma is similar to that of small cell lung cancer, which has similar morphological and biological features. Gastrointestinal stromal tumor is known to be associated with alterations in the c-KIT and platelet-derived growth factor receptor genes and, if resectable, is treated in accordance with the modified Fletcher classification. Carcinosarcoma is generally resistant to both chemotherapy and radiotherapy and requires multimodal treatments such as surgery plus chemotherapy to achieve cure. Primary malignant melanoma is resistant to cytotoxic chemotherapy, but immune checkpoint inhibitors have recently demonstrated efficacy for malignant melanoma of the esophagus. This review focuses on the current status and future perspectives for rare cancer of the esophagus.

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Esophageal Carcinosarcoma with Basaloid Squamous Cell Carcinoma: A Case Report and Review of the Literature

Cited by 8 publications

References 29 publications

Misdiagnosis of an elevated lesion in the esophagus: A case report

Misdiagnosis of an elevated lesion in the esophagus: A case report

Endoscopic palliative resection of a giant 26-cm esophageal tumor: A case report

Rare malignant neoplasm of the esophagus: current status and future perspectives

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