Wu Zhu, Ma Jian-Yang, Yang Jun-Jie, Zhao Yong-Fan, Zhang Shang-Fu
Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2004 Dec 15;10(24):3680-2. doi: 10.3748/wjg.v10.i24.3680.
To analyze the clinical manifestations, pathological features and treatment of primary small cell carcinoma (SCC) of the esophagus and to review the literature on this entity.
The records of 9 patients with primary esophageal small cell carcinoma were examined and the demographic data, presenting symptoms, methods of tumor diagnosis, and types of treatment given, response to treatment, pathologic findings, and clinical outcome were reviewed. Features of mixed patterns of histological differentiation and lymph node metastases were specifically sought.
All the patients reported dysphagia, weight loss and chest pain as the initial symptoms. In 5 cases the tumors were located in the mid-esophagus, 3 cases in the lower third of the esophagus and 1 case in the upper third. The average length of esophageal involvement was 5 cm. They underwent radical resection, regional lymph node clearance and esophageal-stomach anastomosis in thorax or at neck. Two patients had a stage IIa disease, five had a stage IIb disease, and the other two had a stage III disease of International Union Contrele Cancer (UICC). All of them were histologically and immunohistochemically confirmed SCC of esophagus. Immunohistochemical staining for neuron-specific enolase (NSE), synaptophsin (Syn) and chromogranin A exhibited strong immunoreactivity in all specimens. Three of the nine resected specimens showed foci of squamous cell carcinoma in situ. Metastasis was present in 7 of 9 adjacent lymph nodes. All the patients survived the operations and made an uneventful postoperative recovery. They received adjuvant systemic chemotherapy and local radiation therapy after discharge. During follow-up, three patients developed multiple liver, brain, lung and bone metastases and died between 5 and 18 mo after the diagnosis. Three patients developed widespread metastasis disease and died between 18 and 37 mo after the diagnosis. There was no local tumor recurrence in these 6 patients. The other three patients were lost during follow-up.
Primary small cell carcinoma of the esophagus is a rare but very malignant tumor. Radical resection combined with chemotherapy and radiotherapy is helpful in limited stage cases.
分析原发性食管小细胞癌（SCC）的临床表现、病理特征及治疗方法，并复习相关文献。
检查9例原发性食管小细胞癌患者的病历，回顾其人口统计学数据、症状表现、肿瘤诊断方法、治疗方式、治疗反应、病理结果及临床结局。特别关注组织学分化混合模式及淋巴结转移的特征。
所有患者均以吞咽困难、体重减轻和胸痛为首发症状。5例肿瘤位于食管中段，3例位于食管下三分之一段，1例位于食管上三分之一段。食管受累平均长度为5cm。患者接受了根治性切除、区域淋巴结清扫及胸内或颈部食管胃吻合术。2例患者为国际抗癌联盟（UICC）IIa期疾病，5例为IIb期疾病，另外2例为III期疾病。所有患者经组织学和免疫组织化学确诊为食管SCC。神经元特异性烯醇化酶（NSE）、突触素（Syn）和嗜铬粒蛋白A的免疫组织化学染色在所有标本中均显示强免疫反应性。9例切除标本中有3例显示原位鳞状细胞癌灶。9例中有7例出现相邻淋巴结转移。所有患者均顺利度过手术，术后恢复良好。出院后接受辅助全身化疗和局部放疗。随访期间，3例患者发生多发肝、脑、肺和骨转移，诊断后5至18个月死亡。3例患者发生广泛转移疾病，诊断后18至37个月死亡。这6例患者均无局部肿瘤复发。另外3例患者在随访期间失访。
原发性食管小细胞癌是一种罕见但恶性程度很高的肿瘤。根治性切除联合化疗和放疗对局限期病例有帮助。
