Ohtaka Masahiko, Kumasaka Toshio, Nobukawa Bunsei, Hirai Shu, Suda Koichi, Ohno Yasuhiko, Iwazaki Ryozo, Ikegami Yasushi, Fukasawa Masaki
Department of Pathology, Juntendo University, School of Medicine, Tokyo, Japan.
Pathol Int. 2002 Oct;52(10):657-63. doi: 10.1046/j.1440-1827.2002.01407.x.
We report a case of carcinosarcoma of the esophagus characterized by ductal and myoepithelial differentiation. A 61-year-old man was operated on for a polypoid tumor of the distal esophagus. Histologically, this tumor was composed of ductal structures and sarcomatous spindle cells surrounding the ducts at the central area of the tumor. The tumor was also composed of squamous cell and basaloid carcinoma in the periphery. Immunohistochemically, a few spindle cells surrounding the ductal structures showed immunopositivity for alpha-smooth muscle actin and S-100 protein. Electron microscopy revealed that the spindle cells had tonofilament and pinocytic vesicles in the cytoplasm, and basal lamina adjacent to the cytoplasmic membrane. Both of the results strongly supported the suggestion that the spindle cells may be myoepithelial cells. Basaloid carcinoma showed a gradual transition to chondrosarcomatous cells producing the matrix, which had both immunopositivities for S-100 protein and cytokeratin. Therefore, chondrosarcomatous cells may be derived from carcinoma cells. The histogenesis of this tumor may be associated with a totipotent stem cell of esophageal mucosa, which has the potential to differentiate into squamous cells, ductal cells or myoepithelial cells.
我们报告一例具有导管和肌上皮分化特征的食管癌肉瘤病例。一名61岁男性因远端食管息肉样肿瘤接受手术。组织学上，该肿瘤由导管结构和位于肿瘤中心区域围绕导管的肉瘤样梭形细胞组成。肿瘤周边还由鳞状细胞癌和基底样癌组成。免疫组织化学显示，围绕导管结构的一些梭形细胞对α-平滑肌肌动蛋白和S-100蛋白呈免疫阳性。电子显微镜显示梭形细胞在细胞质中有张力丝和吞饮小泡，且细胞质膜附近有基膜。这两个结果都有力地支持了梭形细胞可能是肌上皮细胞的推测。基底样癌显示出向产生基质的软骨肉瘤样细胞逐渐转变，这些细胞对S-100蛋白和细胞角蛋白均呈免疫阳性。因此，软骨肉瘤样细胞可能来源于癌细胞。该肿瘤的组织发生可能与食管黏膜的全能干细胞有关，这种干细胞有分化为鳞状细胞、导管细胞或肌上皮细胞的潜能。
