Primary Oat Cell Carcinoma of the Esophagus

A case of primary oat cell carcinoma of the esophagus is presented. Clinical, radiological, and pathological findings in our case and those reported earlier were reviewed. Primary oat cell carcinoma of the esophagus should be suspected in patients with symptoms of dysphagia, radiating pain to the back with bulky mass on the esophagogram, and diffuse metastasis.     

Esophageal Small Cell Carcinoma with Ectopic Production of Parathyroid Hormone-Related Protein (PTHrp), Secretin, and Granulocyte Colony-Stimulating Factor (G-CSF)

A patient with primary small cell carcinoma of the esophagus is reported, in whom we have studied the secretion of a variety of hormones and cytokines. The tumor was an intermediate cell type of small cell carcinoma and had either epithelial and neuroendocrinological characteristics. Furthermore, hypercalcemia and neutrophilia were present, and the tumor was shown to produce PTHrp, secretin, and G-CSF. The present case is the first report of primary small cell carcinoma of the esophagus with ectopic production of PTHrp, secretin, and G-CSF.     

Small cell carcinoma: an unusual location in a young healthy female

Small cell carcinoma (SCC) is most commonly found in the lung but is occasionally found in the gastrointestinal tract and other extrapulmonary sites. Incidences of SCC in the esophagus and stomach are rare and have been reported almost exclusively in older individuals. The following case presents the discovery of small cell carcinoma of the stomach and esophagus in a 35 year old woman, which is the youngest reported incidence of this to date. Additionally, her course reflects the importance of early diagnostic endoscopy with biopsy and adequate sampling with appropriate immunohistochemical staining when malignancy is in the differential diagnosis, regardless of age or risk factors.     

Small cell carcinoma of the esophagus; clinicopathological and immunohistochemical analysis of six cases

Small cell carcinoma arising in the esophagus is a relatively rare disease. In the more common small cell carcinoma of the lung, the diagnostic significance of several new markers has been recently reported. This study used immunohistochemical techniques in addition to clinicopathological analysis, in order to clarify the utility of newer markers as biological parameters or as diagnostic tools. Six patients with small cell carcinoma of the esophagus were clinicopathologically analyzed. Immunohistochemical staining was performed using primary antibodies for bombesin, CD56 and CD57 in addition to conventional endocrine markers chromogranin A, neuron specific enolase and synaptophysin. All patients died within 2 years of surgery due to cancer recurrence, whether or not they had received adjuvant therapy. Pathological stages ranged from IIa to IVb and lymph node metastasis was observed in five cases. Of the six cases, four showed a positive reaction for bombesin and five were positive for CD57. In contrast, no cases revealed a positive reaction for CD56. The one case to survive 24 months after surgery was not shown to express bombesin, CD56 or CD57. Small cell carcinoma of the esophagus demonstrated an unfavorable prognosis. The study suggested that in this disease, bombesin and CD57 (but not CD56) were useful as biological markers, predicting clinical outcome rather than having diagnostic significance.     

Multiple granular cell tumors of the gastrointestinal tract with subsequent development of esophageal squamous carcinoma

Summary A 52-year-old woman initially presented to our medical center with synchronous, submucosal tumors of the esophagus, stomach, and transverse colon. The gastric and colonic tumors were resected, and both displayed infiltrating sheets of polygonal cells with coarsely granular cytoplasm and small vesicular nuclei. The neoplastic cells of both tumors were immunoreactive for S-100 protein. Ultrastructural studies revealed the lysosomal nature of the cytoplasmic granules. Although the esophageal mass was not resected, it was felt that this represented another focus of granular cell tumor of the gastrointestinal tract. Two years later, she presented with disseminated squamous carcinoma of the esophagus. At autopsy, a submucosal granular cell tumor was found adjacent to the squamous carcinoma of the esophagus. To our knowledge, this is the first reported case of synchronous granular cell tumors that involved multiple segments of the gastrointestinal tract, one of which was later associated with a squamous carcinoma of the esophagus.     

Small Cell Carcinoma of the Stomach: A Clinicopathologic Study of 17 Cases

Of 17 cases of small cell carcinoma of the stomach, three were early and 14 were advanced. Grossly, the tumors were mostly polypoid at the early stage, and as they advanced, deep ulcerations developed. Histologically, only one tumor was "oat cell type," and the other 16 were "intermediate cell type." With regard to tumor components, five were "pure" tumor, and 12 were "composite" admixing glandular and/or squamous differentiation. Argyrophil cells were seen in eight tumors. Immunohistochemically positive cells for chromogranin, neuron-specific enolase, and keratin were seen in 12, 10, and 7 tumors, respectively. Carcinoembryonic antigen was negative in the small cell component of most tumors as opposed to strong positivity in the glandular component. Electron-dense core granules were evident in seven of nine tumors examined. These findings suggest that histologic variety is quite characteristic of the small cell carcinomas of the stomach, and this type of carcinoma takes an aggressive clinical course like its counterparts in other organs.     

Concurrent superficial squamous cell carcinoma of the esophagus and early gastric adenocarcinoma. Report of a case.

We report a patient with concurrent superficial carcinomas of the esophagus and stomach. The tumors occurred in a 68-year-old woman. The esophageal tumor was an intramucosal squamous cell carcinoma, and the gastric tumor an intramucosal adenocarcinoma, type III in the Japanese classification of early gastric cancer. This is the first reported case of associated superficial esophageal and gastric cancers originating from a Western country. Such an association may be more frequent than realized, and therefore it is important to examine both the stomach and esophagus if a patient has one of these tumors.     

Small Cell Carcinoma of the Esophagus in a Patient with Longstanding Primary Achalasia

Achalasia is believed to be a predisposing factor for the development of esophageal cancer. Small cell carcinoma of the esophagus is a rare neoplasm, with fewer than 150 cases having been reported in the world literature, and it has been described only once previously in a patient with longstanding achalasia. We describe a case of an 85-yr-old woman with long-term primary achalasia who developed primary small cell carcinoma of the esophagus. We hypothesize that this patient's recurrent, worsening dysphagia is related to a paraneoplastic phenomenon. We discuss this association and review the literature.     

Varicoid Carcinoma of the Esophagus

A patient with varicoid carcinoma of the esophagus is reported. These tumors differ from classical esophageal carcinoma and have some resemblance to esophageal varices in their radiological and endoscopic appearances. Dysphagia is generally not the presenting symptom. The histological picture in our patient was that of a poorly differentiated adenocarcinoma with areas of signet-cell carcinoma. This is an exceptional finding since all previously reported cases of varicoid carcinoma of the esophagus have been squamous cell carcinomas.     

An Endoscopically Resected Case of Early Carcinoma of the Duodenal Bulb

We report here on a case of early carcinoma originating in the duodenal bulb. The patient was a 70-year-old woman who complained of nausea. A gastrointestinal endoscopy disclosed a lesion protruding from the duodenal bulb and a biopsy revealed adenocarcinoma. According to the results of the endoscopy, the tumor was subpedunculated and probably confined in the mucosal layer. Based on these findings, we performed an endoscopic tumor resection. A histological examination of the resected specimen revealed a papillotubular adenocarcinoma (1.7 × 1.2 × 0.8 cm) localized in the mucosal layer. No carcinomatous lesion was left in the resected margin. No symptoms of recurrence have been noted during the last 6 months. When considering clinical pathology of the present case, we assessed 39 cases of primary early carcinoma in the duodenal bulb previously reported in the Japanese literature. We considered that our patient was the 14th in Japan with an early carcinoma of the duodenum which was completely excised via endoscopic resection. We expect that endoscopic resection of early duodenal carcinoma will be widely used in the future.     

Carcinoma of the esophagus as a complication of megaesophagus

Summary (1) In a period of 3&frac; years seven cases of carcinoma of the esophagus were seen in patients with megaesophagus of different durations. They are described fully.(2) Attention is called to the fact that the tumor may occur at any level and therefore may be overlooked in a dilated esophagus, because it does not cause stenosis.(3) Chronic esophagitis with ulceration of the mucosa owing to stasis and fermentation in the lumen of the esophagus is considered the most likely cause of cancer.(4) The author advises early radical treatment for megaesophagus as a preventive measure against carcinoma, in view of the exceptional diagnostic difficulties found in long-standing cases of the disease.(5) Subtotal esophagectomy with cervical esophagogastrostomy, bringing the stomach up to the neck through a substernal tunnel, is the author's method of choice for megaesophagus.     

瘦素及其受体在食管鳞癌中的表达意义

目的 探讨瘦素(leptin)及其受体(Ob- Ra、Ob-Rb)与食管鳞癌的关系,为食管鳞癌的发病机制研究提供一定的理论依据.方法 RT- PCR法检测20例正常食管和24例食管鳞癌组织中leptin、Ob-Ra、Ob- Rb的mRNA表达.结果 (1)20例正常食管组织中leptin、Ob- Ra、Ob-Rb的mRNA表达阳性率分别为50.0％、50.0％、40.0％;24例食管鳞癌组织中leptin、Ob- Ra、Ob-Rb的mRNA表达阳性率分别为79.2％、83.3％、83.3％.正常食管组与食管鳞癌组相比差异均有统计学意义(P＜0.05).(2)食管鳞癌组织中leptin、Ob-Ra、Ob-Rb的mRNA相对表达量亦高于正常食管组织,差异均有统计学意义(P＜0.05).结论 瘦素及其受体在食管鳞癌组织中的表达阳性率和相对表达量均高于正常食管组织,提示瘦素及其受体可能在食管鳞癌的发生发展中发挥重要作用.     

Small cell carcinoma of the esophagus with metastasis to the brain: a case report

Small cell carcinoma of the esophagus is a rare disease with early systemic metastasis, and the prognosis remains poor. This present case (a 60-year-old Japanese man) was a small cell carcinoma at the lower third of the esophagus complicated by multiple liver and brain metastases. After the first chemotherapy, endoscopic study showed significant shrinkage of the primary esophageal tumor. About 4 months later, however, a primary tumor formed a deep ulceration, and a CT scan of the abdomen also showed further progression of the liver metastases. One year after starting the therapy, a disturbance in the patient’s right eyesight and awkward movement of his right hand occurred. Brain magnetic resonance imaging revealed several high-density areas compatible with metastasis. Gamma knife radiosurgery for metastatic brain tumors was carried out, and all tumors had shrunk. Unfortunately, the patient’s liver function deteriorated gradually because of the aggravation of liver metastases, and the patient died 1 year and 5 months from the time of diagnosis.     

Primary squamous cell carcinoma of the stomach: a case report with a review of Japanese and Western literature

A case of a 75 year-old male with primary squamous cell carcinoma of the stomach is reported. It is extremely rare to see squamous cell carcinoma developing in the stomach, without being accompanied by a component of adenocarcinoma. Up to the present, 18 Japanese and 62 Western cases of this type of carcinoma have been reported in the literature. The origin of this malignancy has not been well elucidated yet and thus, several plausible hypotheses have been proposed. In this presented case, the tumor consisted of only squamous cell carcinoma and the focus of squamous metaplasia was not found histologically in the adjacent mucosa. Therefore, it may be considered that the carcinoma arises from misplaced squamous cell nests of the stomach.     

Combined choriocarcinoma, neuroendocrine cell carcinoma and tubular adenocarcinoma in the stomach

We described a patient with adenocarcinoma of the stomach combined with choriocarcinoma and neuroendocrine cell carcinoma. An 85-year-old man visited our hospital because of appetite loss. Gastric fiberscopy revealed a large tumor occupying the cardial region and anterior wall of the gastric body. The patient underwent total gastrectomy with lymphnode dissection and partial resection of the liver. Choriocarcinoma, small cell carcinoma and tubular adenocarcinoma existed in the gastric tumor. The choriocarcinomatous foci contained cells positive for beta-subunit of human chorionic gonadotropin （B-hCG） and human placental lactogen mainly in syncytiotrophoblastic cells. The small cell carcinomatous loci contained cells positive for synaptophysin, neuron-specific enolase （NSE）, and chromogranin A. The prognosis for gastric adenocarcinoma with choriocarcinoma and neuroendocrine cell carcinoma is exceedingly poor. This patient died about 2 mo after the first complaint from hepatic failure. This is the first reported case of gastric cancer with these three pathological features.     

Small cell carcinoma of the stomach

Summary Small cell carcinoma of the stomach is an unusual and rare neoplasm with only eight reported cases in the world literature. Like small cell carcinomas elsewhere, they possess rapid growth ability and high propensity to metastasize with short survival. Clinically, small cell carcinoma is indistinguishable from adenocarcinoma. Because of the rarity of gastric small cell carcinoma, there is minimal information available on the optimal treatment. Herein, we report on a patient with metastatic pure small cell carcinoma of the stomach. He underwent palliative surgery and postoperative combination chemotherapy with transient partial response. He died 10 months after diagnosis with progressive widespread disease.     

A Case of Afferent Loop Obstruction Secondary to Recurrent Carcinoma of the Stomach with Ultrasound and CT. Scan Findings

A case of afferent loop obstruction secondary to recurrent carcinoma of the stomach is reported. The patient presented in the early recurrence period with the clinical picture similar to that of pancreatic pseudocyst. This was the first reported case of afferent loop obstruction demonstrated by abdominal ultrasound and C.T. scan. The radiological distinguishing features and similarities of pancreatic pseudocyst and afferent loop obstruction are discussed. This case also shows a rarely reported manifestation of recurrent carcinoma of the stomach.     

Primary small cell carcinoma of esophagus： Report of 9 cases and review of literature

AIM: 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.METHODS: 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.RESULTS: 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 followup, 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.CONCLUSION: 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.     

Early esophageal cancer in patients with a history of gastrectomy for gastric cancer

To detect early esophageal cancer effectively, it is important to select high-risk groups. Because we often see early esophageal cancer after gastrectomy for gastric cancer, we investigated 11 early esophageal cancers treated endoscopically in 7 patients who had undergone gastrectomy for gastric cancer. Their average age was 70.8 ± 5.2 years. Median interval between previous gastrectomy and the diagnosis of esophageal cancer was 10 years. Endoscopic examination revealed mild bile reflux into the remnant stomach and esophagitis, but there was no case of Barrett's esophagus. Histological types were all squamous cell carcinoma. Although it has been reported that cancer development is most frequent in the lower esophagus after gastrectomy, we noticed that the majority of these were located in the middle thoracic esophagus (6/11, 55%), similar to general esophageal cancer. As all cases were detected by a regular checkup, it is important to follow up patients after gastrectomy for gastric cancer.     

CASE REPORT: Spontaneous Gas-Forming Liver Abscess Caused by Salmonella Within Hepatocellular Carcinoma: A Case Report and Review of the Literature

In conclusion, pyogenic liver abscess in hepatocellular carcinoma is unusual. Most of the reported cases occurred after a treatment such as transcatheter arterial embolization or percutaneous ultrasound-guided ethanol injection. Salomonella very rarely causes pyogenic liver abscesses. Only 14 cases have been reported in the English literature since 1911. Salmonella liver abscess occurring within a primary neoplasm is even rarer. There were only two such cases described in patients with hepatocellular carcinoma before. The present case is the third one, but it may be the first case of obvious spontaneous gas-forming liver abscess caused by Salmonella within hepatocellular carcinoma.