Polypoid squamous cell carcinoma of the esophagus

Does protruding type 1 esophageal cancer really have a good response to radiation therapy?-a retrospective observational study

BACKGROUND

It is now well-established that esophageal cancer can be more accurately classified macroscopically on the basis of endoscopic rather than esophagographic findings. Thus far, no studies have reported correlations between responses to radiation therapy (RT) and endoscopically-determined macroscopic type of locally advanced esophageal cancer. In this retrospective study, we therefore aimed to determine such correlations in patients who had undergone at least two follow-up endoscopies.

METHODS

Our study cohort comprised 30 patients who had received radiotherapy for locally advanced squamous cell carcinoma (SCC) of the esophagus from January 2012 to November 2017 at our hospital. The lesions had been classified endoscopically into one of the five types specified by the Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus of the Japanese Society for Esophageal Disease. All patients had received radiotherapy and 27 had received chemotherapy. In accordance with those guidelines, responses to treatment were evaluated endoscopically, a median of 74 days after initiating radiotherapy. Follow-up endoscopy had been performed at least twice in 18/30 patients.

RESULTS

The primary complete response (CR) rate was significantly higher in patients with type 1 disease (protruding) than in those with the other types (χ2 test, P=0.041). The only correlation revealed by logistic regression analysis was between CR rate and macroscopically classified type 1 disease (P=0.05). Disease-specific survival (DSS) did not differ between macroscopically classified types (P=0.31). Patients with clinical T2 disease and ≤ stage IIIA had better outcomes than those with other stages (P=0.041 and 0.025, respectively).

CONCLUSIONS

Macroscopic classification of esophageal carcinoma by endoscopy accurately identifies a group with a higher primary CR rate to chemoradiotherapy (CRT): those with type 1 disease (protruding). However, median DSS did not differ between patients with type 1 disease and those with other types.

A Case of Basaloid Squamous Cell Carcinoma of Polypoid Type in the Esophagus

Basaloid squamous cell carcinoma of the esophagus is very rare. Further, polypoid type of esophageal cancer is also rare. We have recently treated a case of basaloid squamous cell carcinoma which presented as a 1.3-cm esophageal polyp. A 48-year-old woman was referred to our hospital because of a polypoid mass at 36 cm distance from the upper incisor on endoscopic examination, and the result of the biopsy was basaloid squamous cell carcinoma. The patient underwent Ivor Lewis operation with lymph node dissection. Two basaloid squamous cell carcinomas, of 1.3 and 0.4 cm, were diagnosed in the final pathologic examination. Regular periodic follow-up showed no evidence of recurrence or metastasis in the 5-month postoperative period.

Immunohistochemical features of the gastrointestinal tract tumors

Gastrointestinal tract tumors include a wide variety of vastly different tumors and on a whole are one of the most common malignancies in western countries. These tumors often present at late stages as distant metastases which are then biopsied and may be difficult to differentiate without the aid of immunohistochemical stains. With the exception of pancreatic and biliary tumors where there are no distinct immunohistochemical patterns, most gastrointestinal tumors can be differentiated by their unique immunohistochemical profile. As the size of biopsies decrease, the role of immunohistochemical stains will become even more important in determining the origin and differentiation of gastrointestinal tract tumors.

Endoscopic treatment of pseudosarcomatous squamous carcinoma of the esophagus: case report and personal experience

Spindle cell (or pseudosarcomatous) squamous carcinoma (PSC) is a rare malignant neoplasm of the esophagus, potentially capable of causing lymph node and distant metastases. Indications for surgery are the same as for squamous cell carcinoma (SCC) of the esophagus. The aims of this paper were to report a case of endoscopically treated PSC and to review our experience of surgically-treated patients with PSC in order to identify patients potentially suitable for endoscopic treatment. In our series of 4,460 patients with carcinoma of the esophagus observed between 1980 and 2003, 28 (0.6%) had the histological features of PSC. One had a PSC histologically confirmed (8cm-long polyp with a 3cm-large base) and endoscopically treated for high surgical risk. The patient had a close follow-up with endoscopic biopsies and ultrasonography with no local recurrence at 3 years. The overall survival rate was 22% for PSC and 17% for SCC (P = n.s.); after 5 years, the survival rates were 22% and 13%, respectively (P = n.s.). In our opinion the limited tendency to parietal infiltration and the good chance of disclosure in an early stage with endoscopic ultrasonography, justify non-surgical solutions in patients with a high surgical risk, possibly associated with adjuvant chemo- and radiotherapy since lymph node involvement is reported in 50% of cases. The limited number of patients with PSC involved in the present series prevent any significant statistical comparisons between the different groups, but the survival rates were roughly the same in the nonsurgical curative therapy as in the curative resection group, while the chances of survival were significantly lower in patients given palliative surgery and or non-curative treatments (P < 0.05).

Polypoid carcinoma of the esophagus

Polypoid carcinoma of the esophagus is rare and little is known about its clinical and histopathologic features. We reviewed 500 surgical cases of esophageal carcinoma and analyzed 12 polypoid carcinomas. Clinical records were reviewed. Histologic examination was done on an average of 68 sections in each tumor. Immunohistochemical examination for proliferating cell nuclear antigen (PCNA) was done in selected sections. No special findings were seen with respect to age, sex, symptoms, or tumor location. The tumors, however, had several interesting features: 1) the main histologic type was squamous cell carcinoma, but other histologic features such as so-called carcinosarcoma, adenoid cystic carcinoma, and verrucous carcinoma were occasionally seen, 2) bidirectional differentiation to squamous and adenocarcinomatous components was recognized, 3) intraepithelial spreading of the carcinoma was often present, 4) depth of invasion in the wall was often shallow, and 5) the prognosis was relatively good. The PCNA labeling index was well correlated with lymphatic or blood vessel permeation.

Carcinosarcoma of the esophagus: a report of two cases

Among 137 cases of esophageal neoplasms surgically treated at Kobe City General Hospital from 1983 to 1990, there were two patients with a huge polypoid lesion identified as carcinosarcoma by light microscopic examination, both of whom underwent radical resection and esophagogastrostomy. Microscopic examination of the resected specimens revealed the tumors to be composed of carcinomatous and sarcomatous elements. Additional immunohistochemical examination disclosed keratin-positive cells in the carcinomatous element and vimentin-positive cells in the sarcomatous element. In case 1, keratin-positive cells were also found in the sarcomatous element, which suggested that the sarcomatous cells were derived from epithelial cells. Despite the huge size of the tumors, the depth of invasion to the esophageal wall was limited to the mucosal layer in case 1 and the submucosal layer in case 2, and there has been no evidence of recurrence in either case since surgery.

Assessment of adventitial involvement of esophageal carcinoma by endoscopic ultrasonography

The adventitial involvement (AI) of esophageal squamous cell carcinoma in 20 patients was analyzed by endoscopic ultrasonography (EUS) and computed tomography (CT). The findings were compared with the histologic evidence of tumor invasion in the resected specimens. AI was detected as an irregularity or interruption of the third layer of the esophageal wall on ultrasound examination. The overall accuracy in the assessment of depth of tumor invasion by EUS and CT scan was 80% and 68%, respectively. EUS diagnosed AI in 17 patients and detected direct tumor invasion of either the aorta, trachea or pericardium in 7 of them. In 4 patients who had severe stenotic lesions, EUS underestimated the depth of tumor invasion when compared to the histologic findings. Overall, these results, show that EUS when combined with CT scanning is a useful means of preoperatively evaluating tumor invasion in patients with esophageal carcinoma.