20例食管癌肉瘤的诊断与治疗分析

目的食管癌肉瘤是一种罕见病,通过回顾分析本组较大样本食管癌肉瘤的病理及临床特点,探讨其诊断治疗.方法对20例食管癌肉瘤病人的临床资料进行回顾性分析.结果食管癌肉瘤多为覃伞样、息肉样腔内生长,个别呈浸润生长.光镜下肉瘤与癌两种成份共存,瘤体以肉瘤成分为主,表面及蒂多分布癌组织,活检常显示为鳞癌,故术前多不能明确诊断.20例患者中9例侵犯粘膜层,1例浅肌层,4例深肌层,6例侵犯外膜.4例出现淋巴结转移,淋巴转移率20%,转移成分3例鳞癌,1例肉瘤.手术切除率100%.1、3、5年生存期分别为85%、68%、68%.结论食管癌肉瘤是一种低侵袭性,低淋巴转移率,预后尚佳的肿瘤.X线表现为食管腔内息肉样的充盈缺损,轮廓较为光滑整齐,粘膜显示"涂抹征".食管镜活检多显示鳞癌或低分化癌,术前难以确诊.治疗以手术切除为主,必要时辅以放化疗.

Diagnosis and therapy study on esophageal carcinosarcoma of 20 cases

Objective Carcinosarcoma of the esophagus is a rare malignant neoplasm consisting of both carcinomatous and sarcomatous components, which characteristically forms polypoid tumors. Methods To study retrospectively the clinical and pathologic characteristics of esophageal carcinosarcoma in 20 patients. Results Most of the carcinosarcoma were polypoid, some of which were sessile. Microscopic examination of the resected specimens revealed that the tumor was composed of both carcinomatous and sarcomatous elements,however, the surface was covered by cells of squamous cell carcinoma, so that the result of endoscopic biopsy always showed squamous cell carcinoma. The depth of invasion to the esophageal wall was limited to the mucosal layer in 9 cases, and the submucosal layer in 5 cases, and exterior layer in 6 cases. Of the 4 cases with metastasis of lymph nodes, 3 showed carcinomatous components, and 1 case showed sarcomaous component,the rate of the lymph node metastasis was 20%. The curative resection rate was 100%. The one-year survival rate is 85%, and three-year survival rate is 68%, five-year survival rate is 68%. Conclusion The tumor has a better prognosis than that of the squamous cell carcinoma of esophagus. Barium swallow esophagogram shows a large polypoid lesion. The result of endoscopic biopsy always demonstrates squamous cell carcinoma or lower differentiated carcinoma. Radical esophagectomy with lymph node dissection is a necessary therapy for carcinosarcoma. Combined modality therapy employing postoperative radiation may be effective in management of these lesions.