Yamamoto Yuji, Watanabe Yuji, Horiuchi Atushi, Yoshida Motohira, Yukumi Shungo, Sato Koichi, Nakagawa Hiromichi, Sugishita Hiroki, Ishida Naoki, Furuta Satoshi, Kawachi Kanji
Second Department of Surgery, Organ Regenerative Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
Case Rep Gastroenterol. 2008 Sep 30;2(3):330-7. doi: 10.1159/000151584.
Carcinosarcoma of the esophagus is a malignant neoplasm involving both carcinomatous and sarcomatous components. We report a patient with true esophageal carcinosarcoma who underwent laparoscopy-assisted surgery. An upper gastrointestinal barium study revealed a lobulated intraluminal filling defect in the lower intrathoracic esophagus. The patient underwent esophagectomy and regional lymphadenectomy with gastric tube reconstruction by laparoscopy-assisted surgery and thoracotomy. The esophageal hiatus was entered and the mediastinal esophagus was dissected using a laparoscopic approach. Microscopically, the tumor comprised poorly differentiated squamous cell carcinoma and spindle-shaped cells resembling leiomyosarcoma. Immunohistochemically, spindle-shaped sarcomatous cells displayed strongly positive reaction to vimentin and negative reaction to cytokeratin AE1/AE3 and CD68. No transitional zone was seen between sarcomatous and carcinomatous elements. The patient was finally diagnosed with true esophageal carcinosarcoma. Laparoscopic transhiatal esophagectomy seems to be a rational and safe procedure for lower esophageal neoplasms, even for patients with impaired respiratory function.
食管癌肉瘤是一种同时包含癌性和肉瘤性成分的恶性肿瘤。我们报告一例接受腹腔镜辅助手术的真性食管肉瘤患者。上消化道钡餐造影显示胸段食管下段腔内有分叶状充盈缺损。患者接受了腹腔镜辅助手术和开胸食管切除术及区域淋巴结清扫术，并采用胃管重建。进入食管裂孔，采用腹腔镜方法解剖纵隔段食管。显微镜下，肿瘤由低分化鳞状细胞癌和类似平滑肌肉瘤的梭形细胞组成。免疫组化显示，梭形肉瘤细胞波形蛋白呈强阳性反应，细胞角蛋白AE1/AE3和CD68呈阴性反应。肉瘤成分和癌成分之间未见过渡区。该患者最终被诊断为真性食管肉瘤。腹腔镜经裂孔食管切除术对于食管下段肿瘤似乎是一种合理且安全的手术方法，即使对于呼吸功能受损的患者也是如此。
