Esophageal carcinoma is one of the most common malignant tumors in China, and Shantou is the high-incidence area. Histological types of the esophageal tumor are primary for squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Myogenic, neurogenic and angiogenic tumors of the esophagus are relatively frequent, while primary malignant fibrous histiocytoma (MFH) are extremely rare, and only a few cases were reported until now. In this report, three cases polypoid tumor of the esophagus consisting of spindle and pleomorphic sarcomatous tumors cell were confirmed to be MFH of the esophagus by histological, immunohistochemical and electron microscopic methods.
Case 1A 52-year-old man with difficulty in swallowing was admitted to the Department of Surgery, Cancer Affiliated Hospital, Shantou University Medical College. The patient had a long history of laryngeal pain. At a 25 cm distance from the dentition, endoscopy revealed a polyplike neoplasm 5 cm long and 3 cm in diameter on a crus originating from the esophageal wall. Subtotal esophagectomy, cervical esophago-gastrostomy and lymph node dissection were performed. Macroscopically, the tumor was 5 × 3.5 × 3 cm in size and thrombus-like.
Case 2A 70-year-old man presented with a one-month history of difficulty in swallowing. Esophagogram and upper gastrointestinal endoscopy revealed a polypoid mass in the midesophagus. Endoscopic biopsies demonstrated the malignant lesion of tumor. Subtotal esophagectomy, cervical esophagogastrostomy and lymph node dissection were performed. The resected polypoid mass was elliptical and measured 7.3 × 2.8 × 2.5 cm. The tumor surface was eroded with hemorrhage ( Fig. 1), its cut surface being murking gray.
Case 3A 51-year-old man was admitted to the hospital because of dysphagia. An X-ray examination with contrast media revealed a polypoid lesion in the middle part of the esophagus. The endoscopic examination detected a mobile polypoid mass in the esophageal cavity. The preoperative pathological diagnosis confirms it is a squamous cell carcinoma. Subtotal esophagectomy, cervical esophagogastrostomy and lymph node dissection were performed. The resected polypoid mass was elliptical and measured 8 × 5 × 4 cm. The tumor surface was necrosis with hemorrhage, its cut surface being gray.
MethodologySamples from the surgical operation were routinely fixed, embedded and stained with hematoxylin and eoAbstract We reported three cases of polypoid tumor of the esophagus, among them one case of sarcomatous tumor partly covered with superficial squamous cell carcinoma. The sarcoma was consisted of anaplastic spindle and pleomorphic tumor cells, which was similar to malignant fibrous histiocytoma (MFH) of the soft tissue. Diagnosis of the surgery resected specimen was confirmed by histological, immunohistochemical and electron microscopic methods. Both diagnostic and differential diagnostic problems of primary MFH of the esophagus and world medical literatures were discussed.