Adenosquamous carcinoma arising in Barrett''s esophagus

Primary adenocarcinoma of the esophagus is rare in Japan and, in most cases, arises from Barrett's esophagus epithelium. A 72-year-old man reporting heartburn and dysphagia and preoperatively diagnosed with adenosquamous carcinoma arising from Barrett's esophagus underwent thoracic esophagectomy and lymph node dissection in curative resection. Pathological diagnosis of the resected specimen showed adenosquamous carcinoma (coexistent adenocarcinoma and squamous cell carcinoma) invasive to the submucosal layer; metastasis was found in regional lymph nodes. Pathological staging was pT1bN1M0, stage II. Unfortunately, the man died of liver and lung metastasis 17 months postoperatively. To our knowledge, this rare case is only the fifth reported in the English literature on adenosquamous carcinoma arising from Barrett's esophagus.     

Synchronous primary carcinosarcoma and adenosquamous carcinoma of the esophagus

Reports of adenosquamous carcinoma and carcinosarcoma found at the same esophagus are rare in the literature. We report a case of synchronous adenocarcinoma and carcinosarcoma of the esophagus. The sarcomatous components were immunoreactive for vimentin. Carcinoma, sarcoma, and adenocarcinoma cells distinctively metastasized to different lymph nodes. Further investigations are required to reveal the biological behavior of the tumor.     

VEGF-C Expression in Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus

Background Vascular endothelial growth factor C (VEGF-C) is the only factor known to cause lymphangiogenesis. In esophageal cancer the histologic tumor type and lymph node metastasis are independent predictors of recurrence and poor outcome. To evaluate the rule of VEGF-C expression in esophageal cancer, we investigated 113 specimens, 59 squamous cell and 54 adenocarcinomas of the esophagus. Methods The expression of VEGF-C was evaluated using immunohistochemistry (IHC) on 59 paraffin-embedded archival specimens from patients with squamous cell esophageal carcinomas and 54 paraffin-embedded archival specimens of patients with esophageal adenocarcinomas arising in Barrett’s mucosa. All patients had a complete tumor resection. A complete and updated follow-up was available for all patients. Results The expression of VEGF-C was significantly different between the two histological types of esophageal tumors. Patients with squamous cell carcinoma and lymph node metastases had a significantly higher VEGF-C expression (P < 0.01). In patients with adenocarcinoma of the esophagus there was no correlation between VEGF-C expression and clinicopathological parameters. High VEGF-C expression tended to be correlated with poor survival in squamous cell cancer but not in adenocarcinoma of the esophagus. Conclusions The present study indicates that VEGF-C may play a role in tumor progression via lymphangiogenesis in squamous cell carcinoma of the esophagus. This seems not to be true for the adenocarcinoma of the esophagus. These data could help with the understanding of the different onset and characteristics of lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the esophagus.     

Adenosquamous carcinoma of the sigmoid colon treated by the less invasive procedures of endoscopy and laparoscopy: Report of a case

A 51-year-old man demonstrated a positive finding for a fecal occult blood test during a screening examination. Total colonoscopy was therefore performed, and a semi-pedunculated polyp was detected in the sigmoid colon. Although this polyp was suspected of invading the submucosal layer, it was removed endoscopically because the preoperative diagnosis was well-differentiated adenocarcinoma. The pathological findings revealed adenosquamous carcinoma that had invaded the submucosal layer with lymphatic invasion. A laparoscopic bowel resection was then performed and a histopathological examination of the surgical specimen showed metastasis to two regional lymph nodes. The patient is alive and recurrence-free 22 months after the operation. Adenosquamous carcinoma has been reported to be rare and to possess a highly metastatic potential. It consists of both squamous cells and glandular cell components. We report a case of adenosquamous carcinoma of the sigmoid colon treated by less invasive approaches consisting of an endoscopic mucosal resection and a subsequent laparoscopic colectomy.     

Synchronous double carcinoma of the left lung and esophagus; report of a case

A 75-year-old man, who was followed for the atypical epithelium of the stomach, was diagnosed as esophageal carcinoma. Further examination revealed left lung tumor that was suspected of lung carcinoma. Radical operation of the esophageal carcinoma was performed. On 41st postoperative day, after open biopsy for the left lung tumor, left upper lobectomy was performed. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the esophagus and well differentiated adenocarcinoma of the lung. Synchronous double carcinoma of the lung and the esophagus is rare.     

Right hemothorax: An unusual presentation of a Barrett's ulcer perforation

INTRODUCTIONDespite improvements in detection and surgical techniques perforation of the esophagus are lifethreatening. In this case report a rare presentation esophageal perforation due to Barrett's ulceration into an aortic vessel is described.PRESENTATION OF CASEWe report a 42 year old man with known Barrett's esophagus presenting with abdominal pain. Further investigations showed an active intrathoracal hemorrhage due to esophageal perforation at exactly the same site of the known Barret's ulcer one year before. Thoracotomy with evacuation of blood was performed and an aortic branch as bleeding focus was found.DISCUSSIONHemothorax due to esophageal perforation of a benign Barrett's ulcer is rare. The diagnosis of aortoesophageal fistula's can be complicated and its presentation is frequently unspecific and is simply confused with other disorders. Acute thoracotomy is necessary and choice of closure depends on the cause and size of the perforation.CONCLUSIONThis case illustrates the need for maintaining a wide-ranging view of potential casus of hemothorax. The key to survival in patients with aorto-esophageal fistula is maintaining awareness of the condition to allow early diagnosis and operative management of this treatable lesion.     

胆囊腺鳞癌和鳞癌与胆囊腺癌的临床对比研究

目的 探讨胆囊腺鳞癌和鳞癌的临床特点.方法 回顾性分析112例胆囊癌患者的临床资料,将其中11例胆囊腺鳞癌和鳞癌的临床特点和预后与同期收治的101例胆囊腺癌进行比较.结果 腺鳞癌/鳞癌组与腺癌组的肿瘤浸润分期为13或T4的比例分别为100%和53%,两组的差异有统计学意义(X2=7.013,P=0.008).腺鳞癌/鳞癌与进展期腺癌(T3或T4期)的远处转移发生率分别为0和35%,差异有统计学意义(X2=3.900,P=0.048),两组的淋巴结转移率为82%和87%(X2=0.000,P=1.000).腺鳞癌/鳞癌组和进展期的腺癌组的胃肠道侵犯发生率分别为45%和15%,差异无统计学意义(X2=3.618,P=0.054).两组的中位生存期分别为5个月和4个月,生存差异无统计学意义(X2=0.359,P=0.549).结论 胆囊腺鳞癌和鳞癌的局部侵袭性强,而远处转移率低.淋巴结转移情况与腺癌相似.     

原发性食管腺癌的外科治疗

目的总结原发性食管腺癌的临床生物学特征和外科治疗经验。方法回顾性分析1980-2000年间外科治疗的43例原发性食管腺癌患者的临床病理资料。结果43例原发性食管腺癌占同期手术治疗的5638例食管癌的0．8％,均行左后外开胸食管胃部分切除、食管胃手工吻合术。肿瘤位于食管胸中段12例,胸下段31例。食管单纯腺癌14例,腺鳞（棘）癌29例。原发性食管腺癌的淋巴结转移率为65．1％,明显高于食管鳞癌的31．6％。食管腺癌的术后1、3、5年生存率分别为81．4％、46．5％和28．2％,低于食管鳞癌。结论原发性食管腺癌好发于食管下段,淋巴结转移率高,预后较食管鳞癌差。外科手术是其首选治疗方法,早诊断、早治疗以及肿瘤的根治性切除是改善预后的关键,合理的综合治疗有助于提高远期疗效。     

Two surgical cases of synchronous double carcinoma of the lung and esophagus and review of 10 documented cases in Japan]

Synchronous double carcinoma of the lung and the esophagus is extremely rare disease. In Japan, 13 cases have reported by Abo and only 10 clinical cases have been documented so far. We describe two cases of synchronous double carcinoma of the lung and the esophagus. Case 1. A 74-year-old man was admitted to our hospital because of the abnormal shadow of the chest X-ray film. Left upper lobectomy was carried out for the lung carcinoma. Because of dysphagia after surgery, upper GI series and endoscopic biopsy were performed, and midesophageal carcinoma was revealed. Radical operation of the esophageal carcinoma was performed 2 months after the first operation. Pathological diagnosis of the lung tumor and the esophageal tumor were well differentiated adenocarcinoma and moderately differentiated squamous cell carcinoma respectively and both of them were early cancer. After 22 months of the second operation, he is doing well. Case 2. a 66-year-old man was operated on because of the esophageal carcinoma in other hospital. Abnormal shadow appeared in his X-ray film 10 months after operation. Although he received chemotherapy as metastatic lung cancer, bronchoscopic examination revealed it adenocarcinoma. We performed segmental lobectomy to him 17 months after the first operation. Pathological diagnosis was large cell carcinoma of the lung. He is also doing well 18 months after the second operation.     

Long-term survival after three-field lymph-adenectomy for an adenocarcinoma in Barrett’s esophagus with metastasis to Virchow’s node

Here, we report a case of long-term survival after resection of an adenocarcinoma in Barrett’s esophagus with metastasis to Virchow’s node. A 71-year-old women was referred to our hospital with a tumor in the lower third of the thoracic esophagus, located just beneath the tracheal bifurcation because of an hiatal hernia. On admission, she had a palpable lymph node in Virchow’s node. The esophageal tumor and this lymph node were biopsied. They were pathologically found to be an adenocarcinoma in the esophagus which had metastasised to the lymph node. She underwent transthoracic esophagectomy with three-field lymph node dissection. The pathological diagnosis was adenocarcinoma in Barrett’s esophagus with the UICC stage classification of pT1, pN1, pM1-LYM, Stage IVB. She received postoperative chemotherapy of cisplatin combined with 5-fluorouracil. The patient is well without recurrence at 14 years to date after surgery. We recommend thoracoabdominal esophagectomy with three-field lymphadenectomy for an advanced carcinoma in the upper and middle thoracic esophagus regardless of histological types.     

Adenocarcinoma occurring from a sigmoid colostomy 20 years after Hartmann's procedure for rectal cancer: A case report

IntroductionCancer arising from the stoma is relatively rare. There is no established surgical procedure for stomal cancer. Furthermore, when a subcutaneous lymphovascular invasion occurs, there is no consensus on whether lymph node dissection along the lymph flow is required. We diagnosed colorectal cancer 20 years after radical resection of rectal cancer.Presentation of caseWe encountered a 70-year-old man who had undergone Hartmann's procedure for rectal cancer 20 years before consultation. Colonoscopy revealed a 30-mm-sized sub-pedunculated polyp with a base at the stoma, and a well-differentiated adenocarcinoma was detected. Approximately 30 mm of the intestinal tract, including the stoma and skin in contact with the tumor, was resected. Pathological examination revealed submucosal invasive cancer with infiltration into the resected skin dermis and invasion of lymphatic vessels under the mucosa. Surgical margins were negative.DiscussionIt is thought that several causes overlap for stomal cancer, although a clear cause of occurrence is yet to be identified. However, as no established surgical procedure exists, the necessity for resection of the lymph nodes without exposure appears indisputable. Although it was reported that skin or subcutaneous metastasis in colorectal cancer is generally regarded as a symptom of systemic metastasis, opinions on the subcutaneous dissection margin of stomal cancer are rarely discussed.ConclusionStomal cancer can be observed macroscopically without colonoscopy. Patients and staff engaged in stoma care should be fully aware that continuous observation of the stoma is necessary even after rectal cancer surveillance is complete.     

Spontaneous regression in small cell esophageal carcinoma

Spontaneous regression or remission of cancers has been defined as the disappearance of the malignancies without any treatment or with obviously inadequate treatment. Spontaneous regression is rare, while any case with a small cell carcinoma in the esophagus was not found in the literature. We experienced a 73-year-old man with small-cell carcinoma in the thoracic esophagus whom underwent esophagectomy with lymphadenectomy. A pathological examination of the resected specimens found metastasis from the small cell carcinoma in the mediastinal lymph nodes, but no malignant cells in the esophageal lesion—an ulcer scar from which the biopsy specimen was taken to be a small-cell carcinoma. This may be the first case report that spontaneous regression in a small-cell carcinoma in the esophagus was found by esophagectomy and pathological examination.     

Maxillary Verrucous Carcinoma Coincident With Cervical Lymph Node Metastasis of Colon Adenocarcinoma

Cervical lymph node metastasis is an extremely rare event in oral verrucous carcinoma. Isolated cervical lymph node metastasis of colon cancer is also rare. This article describes a case of maxillary verrucous carcinoma accompanied by colon adenocarcinoma that metastasized to a cervical lymph node in a 69-year-old Japanese woman. During preoperative evaluation for maxillary verrucous carcinoma, enlarged cervical lymph nodes and colon cancer were suspected by positron emission tomography. Colonoscopy with biopsies confirmed primary colon adenocarcinoma. Left radical neck dissection, partial maxillectomy, and full-thickness skin graft to the mucosa of the upper lip were performed before treatment of colon adenocarcinoma. Cervical lymph nodes showed metastasis from colon adenocarcinoma, and right hemicolectomy was performed. This is the first case report of synchronous oral verrucous carcinoma and colon adenocarcinoma with cervical lymph node metastasis.     

肝门部胆管癌病理组织学特征与预后的临床研究

目的：探讨肝门部胆管癌病理组织学特征与预后的关系。方法：回顾性分析1989年6月-2007年3月山东大学齐鲁医院收治的132例肝门部胆管癌组织的病理组织学特征。结果：132例肝门部胆管癌中腺癌121例，占91.7％；黏液细胞癌3例，腺鳞癌2例，鳞癌2例，未分化癌4例，共占8.3％。121例腺癌高、中、低分化分别占24．0％（29／121）、35．5％（43／121），40．5％（49／121）。高中分化腺癌淋巴结转移率和肝转移率分别为27.7％和20．8％，低分化腺癌为57．1％和53．1％。低分化腺癌转移率明显高于高中分化腺癌（P〈0．05）。高中分化腺癌和低分化腺癌术后1、3、5年生存率分别为55．0％、40．0％、15．0％和45．8％、16.7％、0％。高中分化腺癌生存率明显高于低分化腺癌（P〈0．05）。结论：低分化腺癌在肝门部胆管癌的病理分型中占有相当大的比例，并且病理的分化程度与肿瘤的侵袭能力和预后关系密切。     

Adenosquamous carcinoma of the gallbladder with tumor thrombus in left portal trunk

We report a surgically resected case of adenosquamous carcinoma of the gallbladder accompanied by portal tumor thrombosis, which is regarded as a rare complication. A 73-year-old man was admitted to our hospital because of epigastralgia. Preoperative examinations led to a diagnosis of advanced gallbladder carcinoma with liver metastasis, and operation was performed. Since intraoperative ultrasonography showed a tumor thrombus in the left main portal trunk originating from the metastatic lesion in the left medial segment of the liver, extended left lobectomy with extrahepatic bile duct resection and lymph node dissection was performed, instead of right trisegmentectomy, as proposed preoperatively. Histological examination revealed adenosquamous carcinoma of the gallbladder with medullary growth that was similar to the hepatocellular carcinoma, most notably in the metastatic lesion of the liver and in the portal tumor thrombus. We discuss the relation between portal tumor thrombosis and medullary tumors, and note the atypical operative method employed.     

Alpha-fetoprotein-producing esophageal adenocarcinoma: Report of a case

This paper describes a rare case of adenocarcinoma located in the middle portion of the esophagus with liver metastasis. An 80-year-old man was admitted to our hospital with dysphagia and vomiting, following which an upper gastrointestinal series and esophagoscopy located an elevated-type carcinoma in the middle thoracic esophagus. Computed tomography revealed an esophageal tumor invading the left atrium and aorta, and multiple intrathoracic lymph node swellings, and an ultrasonograph of the liver showed multiple liver metastases. The serum carcinoembryonic antigen, carbohydrate antigen 19-9, and squamous cell carcinoma-related antigen levels were normal, but the serum alpha-fetoprotein (AFP) level was 351.5 ng/ml. The patient died 124 days after undergoing an esophageal bypass operation. On post-mortem histological examination, the original esophageal tumor was diagnosed as a poorly differentiated adenocarcinoma without a squamous component and immunohistochemical staining for AFP showed positive granules in the cytoplasm. All the metastatic nodules, including the lymph nodes, liver, spleen, and lungs, showed the same histological type and AFP-staining pattern as the original esophageal tumor. To our knowledge, this is the first case of AFP-producing esophageal carcinoma to be reported in Japan.     

Primary adenosquamous carcinoma of ampulla of Vater—A rare case report

INTRODUCTION

Primary adenosquamous carcinoma (ASC) of the ampulla of Vater (AmV) is extremely rare. Carcinoma of the ampulla of Vater tends to manifest early due to biliary outflow obstruction, as opposed to pancreatic neoplasms that often are advanced at the time of diagnosis. Periampullary carcinomas are treated by pancreaticoduodenectomy (PD). Adenosquamous carcinoma carries very dismal prognosis.

PRESENTATION OF CASE

Here we present a case of 58-year-old male who was presented with abdominal pain, jaundice and anorexia with no history of (h/o) pruritus and clay colored stool. All blood investigations were normal except liver function tests (LFTs). Ultrasonography (USG) of abdomen suggestive of periampullary mass with dilated pancreatico-biliary tree. Endoscopic retrograde cholangiopancreatography (E.R.C.P.) demonstrated large deformed and bulky papilla with ulcerated lesion with infiltration in to duodenum. Exploratory laprotomy proceeds Whipple''s pancreaticoduodenectomy done. Histopathology revealed adenocarcinoma of the ampulla of Vater. Immunohistochemistry was confirmatory of adenosquamous carcinoma.

DISCUSSION

Adenosquamous carcinoma (ASC) is defined as a tumor in which both glandular and squamous elements are histologically malignant. Compared to adenocarcinoma, ASC of the AmV is a rare malignancy. Preoperative diagnosis is difficult because of the lack of defining characteristics in imaging studies and the difficulty in acquiring both malignant components by limited biopsy. Periampullary carcinomas are treated by pancreaticoduodenectomy.

CONCLUSION

Adenosquamous carcinoma is a very rare form of cancer of the AmV. Pancreaticoduodenectomy is the treatment of choice though early recurrence and distal metastasis may be encountered after surgery. Follow-up should be more frequent to detect possible early recurrence and distal metastasis.     

Clinical study of forty-two patients who underwent resection for pulmonary adenosquamous carcinoma

Pulmonary adenosquamous carcinoma is a rare malignant tumor as defined by the Japan Lung Cancer Society Classification. At our institution, of the 1,023 patients who underwent resection for primary lung cancer, 42 (4.0%) had adenosquamous carcinoma. Here, we present the clinical features of this malignant tumor. The male : female ratio was low. Many tumors were located peripherally, and the positive rate for carcinoembryonic antigen (CEA) was 54.8%; these clinical findings were similar to those of adenocarcinoma. On the other hand, many tumors had relatively large diameter, and most of the patients were heavy smokers; these findings were consistent with those of squamous cell carcinoma. Hence, the cases of adenosquamous carcinoma had the characteristics of both adenocarcinoma and squamous cell carcinoma. The prognosis of patients with adenosquamous carcinoma was poorer than those of patients with adenocarcinoma and those with squamous cell carcinoma, irrespective of whether it was stages I or II. Adenosquamous carcinoma is characterized by a highly aggressive biological behavior and a high rate of early metastasis. Therefore, even if the diagnosis is made at an early phase, an aggressive approach, including adjuvant chemotherapy, might be necessary for adenosquamous carcinoma.     

Carcinoma of the urachus with variable pathological findings: report of a case and review of literature

A 71-year-old man was admitted with the chief complaint of gross hematuria. Cystoscopic examination showed a broadbased papillary tumor at the apex of the bladder. There was edema of the mucous membrane around the tumor. CT-scan demonstrated a mass extending from the bladder dome superiorly. Partial resection of the bladder was done. Pathological examination revealed grade 3 transitional cell carcinoma, with scattered adenocarcinoma and squamous cell carcinoma foci. Chemotherapy with bleomycin (BLM) and cis-dichlorodiamine platinum (CDDP) was done postoperatively. Ten months after the operation, he was readmitted because of recurrence in retroperitoneal lymph nodes. Chemotherapy with BLM and CDDP was done, but he died of pulmonary complications. Autopsy revealed retroperitoneal lymph node metastasis of transitional cell carcinoma. There was no metastasis to any other organ. We briefly discuss 275 cases of the carcinoma of the urachus collected from the Japanese literature.     

Therapeutic strategy for adenocarcinoma in Barrett's esophagus: a study based on a comparison with squamous cell carcinoma]

The therapeutic strategy for adenocarcinoma in Barrett's esophagus is discussed based on a comparison with squamous cell carcinoma. The pattern and range of lymph node metastasis of adenocarcinoma in Barrett's esophagus is similar to that of squamous cell carcinoma, as is the pattern of recurrence. Chemotherapy is less effective, except for some reports on paclitaxel, but chemoradiation therapy is comparable in effect. The general tendency of a better prognosis for patients with carcinoma in Barrett's esophagus is the result of several factors, such as earlier detection of the disease, lower probability of lymph node metastasis, and distal location which permits less radical curative surgical procedures without cervical and superior mediastinal lymph node dissection. In principal the therapeutic strategy for adenocarcinoma in Barrett's esophagus should be determined like that for squamous cell carcinoma, taking into account the location of the lesion and the depth of invasion.