A case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy

We present a case of small cell carcinoma of esophagus treated by chemotherapy with CDDP plus CPT-11 and radiotherapy. A 73-year-old woman visited our hospital with complaints of neck mass and discomfort during swallowing. Upper gastrointestinal endoscopy revealed a type 3 tumor in the middle portion of the esophagus, which was pathologically diagnosed as small cell carcinoma. A computed tomography showed lymph node swelling from neck to mediastinum. Then she was administered chemotherapy with CDDP plus CPT-11 and radiotherapy. The main tumor and lymph node swelling was remarkably reduced by chemoradiotherapy. The prognosis of small cell carcinoma of the esophagus is extremely poor because it may cause a general metastasis in early stage. This case was for long-term survival with chemoradiotherapy, and we report our case with the literature cited.     

食管小细胞癌的临床分析

背景与目的：世界范围内食管癌每年发病约40万例，其中食管小细胞癌（small cell esophageal carcinoma SCEC）发病率较低，国内外治疗方法尚未达成一致，我们对国内21家医院1998-2005年公开发表文献中的676例SCEC和我院收治67例SCEC（共743例）进行回顾性分析，探讨SCEC的临床特点、治疗方法及相应的预后。方法：共收集在不同级别的21家医院诊治的共743例SCEC患者的临床资料，收集年度从1961-2003年，最长39年，最短7年，平均16年：743例SCEC约占同期食管恶性肿瘤中的1．38％，平均发病年龄56．8岁（范围51～66岁），其中男性511例，女性232例，男女之比为2．2：1：743例SCEC发病部位：颈段2例，胸上段68例，胸中段420例，胸下段252例，全食管1例；病变长度平均值5．7cm病变范围1．5～22cm。在阐明病理分期的文献中，Ⅰ期17例，Ⅱ期199例，Ⅲ期204例，Ⅳ期37例。在阐明治疗方法的文献中，单纯手术88例，单纯化疗24例，单纯放射治疗23例，手术＋化疗135例，手术＋放疗26例，放射治疗＋化疗54例，手术＋化疗＋放射治疗37例。结果：单纯手术、放疗、化疗的中位生存期分别为10．8、6．2、6．6个月，而放疗＋化疗、手术＋化疗、手术＋放疗和手术＋放疗＋化疗的中位生存期分别为12．3、16．1、14．7、16．2个月。743例SCEC患者总1、2、3、4、5年平均生存率分别为56．4％、27％、19．3％、11．1ck、9．7％。结论：对于食管小细胞未分化癌，有计划的综合治疗，尤其是早期食管小细胞未分化癌的手术与化疗对患者的治疗更有意义，可以提高远期疗效，延长患者的生存期。     

A case of small cell carcinoma of the esophagus

The case of a 51-year-old man, complaining of a sense of pressure on his chest, is reported. Tests led to a diagnosis of a cancer in the midesophagus and a subtotal esophagectomy was performed. The tumor was found to be a protruded type, 8.5 X 7.0 cm in size. A histologic diagnosis revealed it to be a small cell anaplastic carcinoma. The tumor cells were found negative in a Grimelius staining and did not contain hormones such as ACTH. Some cytokeratins, however, were detected by an immunohistochemical examination, Cancer invasion into the adventitia was seen, though no lymph node metastasis or a distant metastasis was shown. Six months after operation, a recurrence in the mediastinum and in the distant lymph nodes was found. Chemotherapy and irradiation were found to be useful, and the postoperative survival period was 25 months.     

A case of small cell carcinoma of the esophagus

A small cell carcinoma of the esophagus is a rare entity; only 101 cases have been reported in the world literature. In a 59-year-old man, complaining of dysphagia, a tumorous lesion was detected in the esophagus at the upper GI series. The histologic diagnosis of biopsy revealed an undifferentiated carcinoma or a malignant lymphoma. Preoperative radiotherapy was carried out, effectively decreasing the large tumorous lesion in size. Thereafter an esophagectomy and an esophagogastric anastomosis were done. The histologic diagnosis of the resected specimen revealed a small cell carcinoma of an intermediate cell type. The tumor cells failed to show cytoplasmic argyrophilia and an ultrastructural examination did not display any cells containing membrane-bound neurosecretory granules.     

A case report of small cell carcinoma of the esophagus successfully treated by irinotecan and cisplatin

Small cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent and early recurrence against various treatments. We have experienced a case of small cell carcinoma of the esophagus manifested by massive lymph node metastasis in the upper mediastinum successfully treated by CPT-11 and CDDP, and that a patient survived for 17 months after the initial treatment. A 62-year-old man underwent endoscopy due to a disturbance of the food passage. Pathological evaluation of biopsy specimen revealed small cell carcinoma of the esophagus. As he was diagnosed with bilateral lymph node metastasis in the upper mediastinum by CT scan, a systemic chemotherapy with CPT-11 and CDDP was adopted. After 2 courses of chemotherapy he could be discharged as the size of the tumor was reduced. After 3 courses of additional chemotherapy 8 months after the initial treatment, a recurrent tumor was indicated at the right side of the lymph node of the neck. A weekly radiation with concurrent administration of docetaxel was carried out as a second line treatment. He is surviving for 17 months after the initial treatment without any evidence of recurrence. Due to histo-pathological similarity, a treatment for small cell carcinoma of the esophagus resembles that of the lung. Recently, the combined treatment of CPT-11 and CDDP was reported to demonstrate a better influence on a patient's survival for small cell carcinoma of the lung. For the esophagus, CPT-11 and CDDP was also an effective treatment.     

Primary undifferentiated small cell carcinoma of the esophagus: clinicopathological and flow cytometric evaluation of eight cases

We present a clinicopathological and flow cytometric evaluation of eight primary small cell carcinomas of the esophagus representing 1.5% of all esophageal malignancies diagnosed during a 22-year period (1965-1987) in the Tampere University Central Hospital. The mean age of the patients (four male and four female) was 67 years (range 55-75 years). Five cases had distant metastases at the time of diagnosis. Three patients were treated by esophageal resection, one by laser vaporisation, and four by chemotherapy. The median survival time was 4 months (range 9 days to 8 months). A complete local response to chemotherapy in serial esophagogramms was detected in one patient. All four patients given chemotherapy survived longer than those treated with esophageal resection only. Four (67%) of the six carcinomas analyzed by DNA flow cytometry contained DNA-aneuploid stemlines. The median S-phase fraction of these small cell carcinomas was high (16.3%), reflecting rapid cell proliferation rate, which may be related to their responsiveness to chemotherapy.     

Small cell undifferentiated carcinoma of the esophagus. Case report with hormonal studies

This report details clinical and pathologic aspects of a case of small cell undifferentiated carcinoma of the esophagus. Transmission electron microscopic examination demonstrated neurosecretory granules, and indirect immunoperoxidase stain for adrenocorticotropic hormone (ACTH) was positive. However, the authors detected no abnormal hormone levels in urine or blood. The calculated tumor doubling time was approximately 2 days. The fulminant nature of this carcinoma was also evident from the rapid clinical progression in spite of surgical excision, radiotherapy, and chemotherapy.     

Small cell carcinoma (non-oat cell type) of the esophagus concomitant with invasive squamous cell carcinoma and carcinoma in situ. A case report

A case of double primary invasive carcinoma of the esophagus, consisting of well-differentiated squamous cell carcinoma and non-oat cell small cell carcinoma without squamous differentiation, is presented. This is the first reported case of a double or multiple primary invasive carcinoma of the esophagus in which one component is small cell carcinoma (oat cell or non-oat cell). Furthermore, the mucosal epithelium around the non-oat cell small cell carcinoma revealed multiple dysplasia and carcinoma in situ. These lesions were definitely separated from the invasive carcinoma and from each other. The results suggest that pure non-oat cell small cell carcinoma of the esophagus without squamous differentiation is derived from the esophageal squamous epithelium, and is a variant of squamous cell carcinoma.     

A case of multidrug-resistant squamous cell lung carcinoma responding to S-1 plus CPT-11 combination chemotherapy

The patient was a 63-year-old man who consulted our hospital with complaints of a cough and breathing difficulties. His chest CT revealed a 25-mm mass in his right S1 hilar area with spiculation, disseminated nodule in right lung, and pericardial effusions. Also, bronchoscope and TBLB revealed squamous cell carcinoma. This patient was diagnosed as lung cancer (cT4N3M1, stage IV), and chemotherapy was initiated. The chemotherapy was given in the order of CBDCA (AUC3) +GEM (1,000 mg/m(2)), DOC (60 mg/m(2)), and VNR (25 mg/m(2)), and the tumor response was PD. S- 1 (120 mg/body/day, continuous administration for 2 weeks followed by 1 week of rest) was chosen as fourth-line treatment, and a breast CT detected tumor size reduction following completion of the first course. However, after completion of three courses, the breast CT found tumor-enlargement again. Then the chemotherapy was changed to amrubicin (35 mg/m(2)), but the treatment was discontinued due to skin rash. We once experienced a size reduction with S-1, so S-1 (100 mg/body/day, day 1-14) plus CPT-11 (60 mg/m(2), day 1, 7, 14) combination chemotherapy was conducted at 4-week intervals. After two courses were completed, tumor size reduction was observed by breast XP and CT. The response rate was 40.0%. Currently, seven courses were completed, and we will continue this treatment due to the tumor response of SD. The S-1 single treatment and S-1+CPT-11 combination chemotherapy showed efficacy for this difficult case of NSCLC with refractoriness to multiple cancer drug chemotherapy. This combination treatment should be investigated further for its therapeutic benefit.     

Superficial small cell carcinoma of esophagus treated by endoscopic mucosal resection combined with chemoradiotherapy--a case report

The patient was a 70-year-old woman who was admitted to our hospital for positive fecal occult blood. Upper gastrointestinal endoscopy revealed a superficial plateau-type (0- I sep) submucosal cancer on the right wall of the esophagus 28 cm from the incisor. Biopsy revealed small cell carcinoma. CT scan detected neither lymph node metastasis, nor distant organ metastasis. Endoscopic mucosal resection (EMR) was performed. Post-EMR chemoradiotherapies were conducted. The patient has lived with no evidence of cancer recurrence for 40 months. This was the first case of esophageal small cell carcinoma treated by EMR combined with chemoradiotherapy.     

A case of small cell undifferentiated carcinoma (SCUC) of the rectum treated with etoposide, cis-platinum and radiotherapy]

A 29-year-old-woman with recurrent cancer of rectum was treated with Etoposide, cis-platinum and external irradiation. Previous postoperative chemotherapies consisted of MMC, CPA, VCR and HCFU. Histologically, the tumor invaded in sheets and nests, and consisted of round to ovoid malignant cells with high nuclear/cytoplasmic and hyperchromatic nuclei with a coarse, clumped, or stippled chromatin pattern. Most cells demonstrated a positive reaction by Grimelius and NSE staining. Eight months after surgery, we switched to Etoposide cis-platinum and external irradiation, because of local recurrence. Etoposide (total 725 mg) and cis-platinum (total 100 mg) were injected into bilateral iliac artery and 60 Gy radiotherapy was performed. The patient showed a good response, and a complete response (CR) was evident for the following 42 months. Thus, Etoposide, Cis-platinum and radiotherapy are considered an effective combination therapy for a patient with small cell undifferentiated carcinoma.     

Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction

BACKGROUND: Patients with localized esophageal carcinoma often develop locoregional and distant disease recurrence. The current study investigated the outcome of a new chemotherapy combination as induction therapy before chemoradiotherapy. METHODS: Forty-three patients with resectable carcinoma of the esophagus or gastroesophageal junction were enrolled. Most of the tumors were endoscopic ultrasonography (EUS) (EUS)T3 (84%) and (EUS)N1 (63%). The patients received < or = 2 6-week cycles of CPT-11 and cisplatin followed by chemoradiotherapy (45 grays with 5-fluorouracil and paclitaxel). Five to six weeks after chemoradiotherapy, the patients underwent staging and surgery. The feasibility, curative resection rates, overall and disease-free survival rates, rate of significant pathologic response, and patterns of disease recurrence were assessed. RESULTS: Of the 43 patients, 39 (91%) underwent an R0 resection. Two patients (5%) died after surgery. A pathologic complete response (pathCR) was observed in 11 (28%) of the 39 patients (or 26% of the 43 patients). In addition, 16 patients (41% of 39 patients or 37% of 43 patients) had < 10% viable tumor in the surgical specimen (pathPR). A comparison of endoscopic ultrasonograpy T and N classifications with surgical T and N classifications demonstrated significant down-staging (P < 0.01). The median survival period of all 43 patients was 22.1 months. Patients who had achieved a pathCR or pathPR had a longer median survival (25.6 months) than those who achieved less than a pathPR (18.5 months; P = 0.52). None of the clinical parameters examined were found to correlate with survival or pathologic response. CONCLUSIONS: CPT-11-based induction chemotherapy resulted in substantial pathCR and pathPR rates, both of which lead to a favorable survival outcome. The three-step strategy needs to be developed further, with the investigation of targeted therapies with chemotherapy and radiotherapy.     

A case of phyllodes tumor with bloody nipple discharge in juvenile patient

We report a rare case of phyllodes tumor of the breast in a juvenile patient with bloody nipple discharge. An 11 -year-old girl had a chief complaint of a palpable 5 cm well-circumscribed tumor with nipple discharge in the left breast. The histopathological diagnosis of the resected specimen was benign phyllodes tumor showing extensive areas of hemorrhagic necrosis. The bloody nipple discharge was caused by spontaneous infarction of the tumor. Preoperative ultrasonography and galactography were helpful in evaluating the mechanism of nipple dicharge from the tumor. Although phyllodes tumor must be differentiated from fibroadenoma, the present case was histopathologically identical to phyllodes tumor.     

A cytologic study on small cell carcinoma of the esophagus.

The cytologic picture of small cell carcinoma primarily arising from the esophagus was studied with 7 cases which were confirmed by histologic examination. Cytomorphologic characteristics of small cell carcinoma of the esophagus are as follows: the arrangement of groups of tumor cells is irregular and overlapping with indistinct cell boundaries. The cytoplasm is small, or sometimes absent. The nuclei are round, oval or occasionally spindle shaped. Nuclear borders are thin. The chromatin of finely granular pattern has increased and is evenly distributed.     

Endocrine function in small cell undifferentiated carcinoma of the lung

The endocrine status of 106 patients with undifferentiated small cell carcinoma of the lung was evaluated before treatment was begun. Almost one half of the patients had evidence of abnormal control of the secretion of adrenal cortical steroids, manifested by loss of diurnal rhythmicity or dexamethasone suppressibility. Only two had the clinical syndrome of ectopic ACTH secretion. Evidence of inappropriate secretion of vasopressin was found in 38% of the patients, most of whom also had abnormalities of corticosteroid secretory pattern. About one half of the patients had evidence of abnormal glucose tolerance, and many also had a paradoxical rise of plasma growth hormone concentration after glucose administration. The levels of the other hormones studies were normal. The pattern of hormone abnormality observed in these patients appears to be relatively specific for small cell undifferentiated carcinoma, and is different from that observed in other pulmonary tumors. Patients with abnormal control of plasma cortisol had a worse prognosis than those with normal adrenal function, largely because of decreased response rates to chemotherapy. Other endocrine abnormalities were of no prognostic significance.     

A case of endocrine cell carcinoma of the esophagus successfully treated by chemoradiotherapy

The patient was a 74-year-old man who suffered from epigastric abdominal pain. He visited our hospital in April 2008. An esophageal endocrine cell carcinoma was pointed out by gastrointestinal endoscopy, and he was diagnosed as esophageal endoscopic cell carcinoma with mediastinum lymph node by CT scan(Stage IVa: cT3N4M0). Concurrent chemoradiotherapy using CDDP+EP was started. After two courses, the primary tumor was markedly reduced, and endoscopy showed only a scar. We diagnosed the patient as being in complete remission. However, CT showed a liver metastasis relapse in June 2009, and we started AMR as second-line chemotherapy. His general condition went into a decline, however, He died on October 2, 2009.     

Primary neuroendocrine small cell undifferentiated carcinoma of the parotid gland

Neuroendocrine small cell carcinoma is a malignant neoplasm that most frequently arises in the lung. Salivary gland involvement is rare, and the parotid is the main gland affected. We describe the fine-needle aspiration (FNA) cytology findings, the immunophenotypical study and the differential diagnosis of a small cell carcinoma that presented in the parotid of a 91-year-old man. The tumour was treated only with radiotherapy and presented a complete response, with no evidence of the disease after three years of follow-up. This is the first case reported in the literature with good outcome after exclusive irradiation.     

Clinicopathologic Observations on Small Cell Carcinoma of the Esophagus

OBJECTIVE To investigate the histogenesis and biological characteristics and factors influencing prognosis of small cell carcinoma of the esophagus(ESCC).METHODS The expression of CK, NSE, Syn, CHr-A and CD56 proteins were detected immunohistochemically in 63 cases of small cell carcinoma of the esophagus.RESULTS The ESCC cases were divided into two groups as follows: a puresmall cell group (28/63) and compound small cell group (35/63). Theimmunohistochemistry results were positive for: CK in 41.3%, NSE in 36.5%,Syn in 90.5%, CHr-A in 60.3% and CD56 in 50.8%. The difference betweenstaining of the pure small cell carcinoma and compound small cellcarcinoma was not statistically significant. The size and depth of tumorinvasion, the positive residual incision edge and lymph node metastasiswere the major factors influencing long-term survival.CONCLUSION Small cell carcinoma of the esophagus is a highly malignanttumor, which expresses neuroendocrine antigens. The histophathologicorigin is still unknown but the non-neuroepithelial origin was accepted in thisstudy.