Sarcomatoid Carcinoma of the Esophagus - Abstract
Background: Sarcomatoid carcinoma of the esophagus is an unusual malignancy
with a biphasic histological appearance containing both epithelial and mesenchymal
elements. The most common epithelial component is squamous cell carcinoma; the
spindle cell component is typically high grade. These tumors usually present as large
pedunculated masses with intraluminal growth but show minimal invasion.
Aims: We report three cases of esophageal sarcomatoid carcinoma with relatively
uncommon morphologic and clinical features, and further discuss the biological and
clinical behaviors of this rare tumor.
Methods: The pathology database was retrospectively searched and three cases
of esophageal sarcomatoid carcinoma were retrieved. These cases were thoroughly
reviewed and summarized.
Results: All three tumors exhibited a prominent spindle cell component with
variable nuclear pleomorphism and cytokeratin/p63 expression. Osteoid formation
was present in one case. The epithelial component also varied. Case1 contained
keratinizing squamous cell carcinoma with in situ component, composing of 10% of the
tumor volume. In case 2, the bulk of the tumor was non-keratinizing basaloid squamous
cell carcinoma without carcinoma in situ. Case 3 was biopsy only and no carcinomatous
component was present. These tumors also showed unusual clinical behaviors. In case
1, the patient developed peritoneal metastasis and anastomotic recurrence at 4
months after surgery despite clear margins and exophytic tumor growth with only
focal muscularis porpria invasion. In contrast, in the other two cases with invasive tumor
growth, both patients survived more than 5 years.
Conclusion: Many aspects of sarcomatoid carcinoma remain unclear. Further
investigation is necessary to elucidate the etiology, pathogenesis, biological and clinical
behaviors of this rare tumor.