食管肉瘤样癌的临床病理分析

李常山; 许京中; 田胜花; 孟庆民; 王刚平

文章摘要

Changshan Li,Jingzhong Xu,Shenghua Tian,Qingmin Meng,Gangping Wang. Clinical pathology analysis of esophageal sarcomatoid carcinoma. Oncol Transl Med, 2014, 13: 235-239.

食管肉瘤样癌的临床病理分析

Clinical pathology analysis of esophageal sarcomatoid carcinoma

DOI：

中文关键词: 食管肿瘤；肉瘤样癌；钡剂造影；体层摄影术； X 线计算机；临床；影像学；病理；诊断，鉴别诊断

英文关键词: esophagus; sarcomatoid carcinoma; barium sulfate; tomography, X-ray computer; pathology; diagnosis

基金项目:

Author Name	Affiliation
Changshan Li	Department of Radiology, Rizhao People’s Hospital, Rizhao 276826, China
Jingzhong Xu	Department of Internal Medicine, Rizhao Jufeng Hospital, Rizhao 276812, China
Shenghua Tian	Department of Internal Medicine, Rizhao Traditional Chinese Medicine Hospital, Rizhao 276800, China
Qingmin Meng	Department of Radiology, The Central Hospital of Tai'an, Tai’an 271000, China
Gangping Wang	Department of Clinical Pathology, Rizhao People’s Hospital, Rizhao 276826, China

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中文摘要:

目的：研究食管肉瘤样癌的临床、影像学及病理特征。方法：回顾性分析2006年1月至2013年12月间四家医院住院经手术病理证实的23例食管肉瘤样癌患者的临床影像学资料，对照病理学分析其影像学特征。23例均进行了上消化道钡剂造影检查，14例行螺旋CT扫描。其影像学资料包括肿瘤部位、大小、形状、质地硬度等，病理学资料包括肿瘤病理生物学因素及免疫组织化学UltraSensitiveTM S-P检测细胞角蛋白AE1/AE3、34βE12、P63、Vimentin、desmin、Actin、S-100 和 Ki-67，分析其关系。结果：上消化道钡剂造影、CT扫描及内镜检查显示肿瘤大小 0.4cm ~5.7×3.5×1.3cm(平均3. 7cm)，食管中段14例，食管下段7例，食管上段2例。23例肉瘤样癌中，19例为息肉型蕈伞型，2例为溃疡型，2例髓质型。肿瘤表面相对较光滑，食管黏膜面较规整，病理改变主要有轻度堵塞，钡剂通过不畅，部分管壁僵硬，食管腔扩大。正常食管无明显缩窄。CT显示管腔内肿块，3例8个肿大淋巴结（病理显示5例17个淋巴结转移）。病理组织学上可见癌与肉瘤样结构两种成分，癌主要是分化差的鳞状细胞癌，肉瘤样结构为梭形细胞，类似于平滑肌肉瘤。免疫组织化学梭形细胞肉瘤肉瘤样成分显示细胞角蛋白AE1/AE3弱阳性。 5例可见癌与肉瘤样结构间存在移行区域，23例中共查见187枚淋巴结，其中5例53枚淋巴结中有17枚淋巴结转移。结论: 食管肉瘤样癌临床症状出现晚，病史较长，影像学表型主要为食管腔内较大的息肉状分叶样肿块，多带蒂，局部食管腔扩张，管壁僵硬不明显, CT检查有助于食管肉瘤样癌的术前分期。食管肉瘤样癌具有独特的影像学特征，内镜下活检是术前确诊的主要手段，最终需病理组织学及免疫组化确诊食管肉瘤样癌临床病理特征类似于食管其他肿瘤, 影像学表型主要为食管腔内较大的息肉状充盈缺损，分叶征及圆顶征，肿块多带蒂，局部食管腔扩张，管壁僵硬不明显。组织学上可见癌和肉瘤样两相模式共存，这是该肿瘤诊断的关键特性。然而,肉瘤样癌比其他恶性食管肿瘤预后要好。免疫组织化学染色帮助鉴别其他食管肿瘤。

英文摘要:

Objective: The purpose of this study was to study the clinical, imaging characters and pathological characteristics of esophageal sarcomatoid carcinoma. Methods: We reviewed 23 cases of esophageal sarcomatoid carcinoma from January 2006 to December 2013 in four hospitals. The data of patients who were esophageal sarcomatoid carcinoma operated were retrospectively analyzed. All cases had completed upper gastrointestinal barium images materials and 14 of these cases had completed CT images materials. Upper gastrointestinal barium images and CT imaging features include tumor location, size, shape, and strengthen, etc. The biological parameters of lesions including the express of cytokeratin AE1/AE3, 34βE12, p63, Vimentin, desmin, Actin, S-100 and Ki-67 detected by immunhistochemical UltraSensitiveTM S-P method (n = 23), and the patients’ data of contrastographic picture (n = 23), imaging characters of CT scan (n = 14), and their relationship were studied. Results: Upper gastrointestinal barium images, CT imaging and gastrointestinal fiberscopy revealed lobulated intraluminal filling defect 0.4 cm to 5.7 cm × 3.5 cm × 1.3 cm (mean = 3. 7 cm) in the mid (n = 14), lower (n = 7) and upper (n = 2) intrathoracic esophagus. Among 23 cases of esophageal sarcomatoid carcinoma, 19 patients were of mushroom type, 2 patients was of ulcer type, and 2 patients were of medulla type; 19 patients were pedunculated, and 4 patients were no pedunculated (2 patients was of ulcer type). The tumor surface was relatively smooth and esophageal compliance was maintained. The pathological changes of esophagus such as lightly locked, rigid wall no-manifest partly, esophageal lumens expand partly, major filling sublobe defect could be shown through contrast medium. Normal esophagus was no unpack obviously over pathological changes. Enhanced computed tomography showed tumors in the intrathoracic esophagus and 8 lymph nodes metastases in 3 cases. Histologically, carcinomatous and sarcomatous components coexist. Microscopically, the tumor comprised poorly differentiated squamous cell carcinoma and spindle-shaped cells resembling leiomyosarcoma. Immunohistochemically, spindle-shaped sarcomatous cells displayed weekly positive reaction to cytokeratin AE1/AE3. Transitional zone was seen between sarcomatous and carcinomatous elements in 5 cases. The 17 lymph nodes metastases in 5 cases (53 lymph nodes) among 23 cases esophageal sarcomatoid carcinoma (187 lymph nodes) were observed. Conclusion: The clinical and radiologic features of esophageal sarcomatoid carcinoma overlap with those of other esophageal neoplasms. There are the radiologic imaging changes such as a large, intraluminal, polypoid mass, major filling sublobe defect and pedicle skin flap tumor in esophageal lumen, esophageal lumen extension partly, dissepiment rigidity wall no obviously, etc. Histologically, carcinomatous and sarcomatous components coexist and the biphasic pattern is the key diagnostic feature. However, esophageal sarcomatoid carcinoma has a more favorable prognosis than other malignant esophageal neoplasms. Immunohistochemical staining seems necessary to distinguish these lesions from other esophageal neoplasms.

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