Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.2111
Peer-review started: February 29, 2020
First decision: April 2, 2020
Revised: April 8, 2020
Accepted: April 28, 2020
Article in press: April 28, 2020
Published online: May 7, 2020
Processing time: 67 Days and 23.1 Hours
Carcinosarcoma (spindle cell carcinoma) of the esophagus is an extremely rare event; the etiology and origins of this neoplasm have not yet been determined. Epithelial-mesenchymal transition (EMT) has been associated with invasion and metastasis, and may be related to the generation of a stem cell population within this tumor.
We present the case of a 61-year-old male with nausea and fever. Upper gastrointestinal endoscopy revealed the presence of type 1 and 0-IIc lesions located 35 cm from the incisors toward the esophago-gastric junction. Thoracoscopic esophagectomy was performed. Macroscopic analysis revealed three polypoid lesions in the abdominal esophagus that accompanied the main lesion in the lower thoracic esophagus and 0-IIc lesions that spread continuously with them. Histologically, the lesions included proliferating spindle cells. Adeno-carcinomatous components were detected in a section near the foot, and squamous cell carcinoma was identified in the mucosa at the base of the tumor. The patient was diagnosed with multiple carcinosarcomas, staged at pT1b (SM3), pN1 (#110, #7), cM0, Stage II (sarcomatous metastasis to the lymph nodes). Spindle cells did not express E-cadherin but were positive for EMT markers, including zinc finger E-box-binding homeobox 1, TWIST, and snail family transcriptional repressor 2. The patient has experienced no recurrence at 5 years and 2 mo after surgery.
This report suggests that multiple sarcomatous tumors may be generated from primary squamous cell carcinoma via mechanisms related to EMT.
Core tip: Epithelial-mesenchymal transition (EMT) has been associated with cancer invasion and metastasis as epithelial cells acquire the ability to migrate and invade; these observations have been related to the generation of a stem cell population within the neoplasm. We report here a resected case of multiple carcinosarcomas with adeno-carcinomatous components that may have developed secondary to EMT. Detailed elucidation of the relationship between the pathogenesis of carcinosarcoma and EMT are among the future challenges in this field.