Primary Esophageal Undifferentiated Carcinoma of Small Cell Type, Report of a Case Yasuhiro Takaki 1,2 , Takashi Hisabe 1 , Fumihito Hirai 1 2Department of Pathology, Fukuoka University, Chikushi Hospital 3Department of Gastroenterology, Fukuoka University, Chikushi Hospital Keyword: 食道腫瘍 , 食道未分化癌 , 食道小細胞癌 , 食道表在癌 , 放射線化学療法 pp.410-415
Published Date 2005/3/25
DOI https://doi.org/10.11477/mf.1403100051
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A 48-year-old man with a complaint of retrosternal pain, was introduced to our hospital with a diagnosis of small cell carcinoma of the middle esophagus. X-ray examination revealed an elevated lesion with smooth margin and irregular barium fleck on the top of the tumor. Endoscopic examination showed a dome-shaped submucosal tumor-like protrusion largely covered with non-neoplastic epithelium and had an eroded central depression(0-Isep). A shallow depression(0-IIc)was also recognized in the adjacent mucosa. Biopsy specimen taken from the central depression was diagnosed as small cell carcinoma(SmCC), and that from peripheral 0-IIc revealed squamous cell carcinoma(SqCC), respectively. EUS revealed a hypoechoic submucosal mass that had expanded into the deeper portion of the submucosal layer. Preoperative CT examination revealed neither lymph node nor distant metastasis. The lesion was diagnosed preoperatively as a primary SmCC of the esophagus, which had invaded as deep as the sm3, without metastases(N0,M0), and the lesion was treated surgically. Gross appearance of the resected specimen showed a whitish submucosal tumor-like protrusion, measuring as much as 17×14 mm in size, with irregular deep ulceration. Histologically, the tumor was mainly situated in the submucosal layer, and was composed of a dense proliferation of small to medium-sized atypical cells with hyperchromatic or granular nuclei and scant cytoplasms arranged in solid nest or sheet-like fashion. Morever, the tumor cells were Grimelius positive, and were immunohistochemically positive for CD56. NSE, and Chromogranin A. SqCC in situ was coexisted separately in the adjacent mucosa. Finally, the tumor was diagnosed histologically as esophageal undifferentiated carcinoma of small cell type, tumor size was 20×18 mm including the concomitant SCC in situ,0-Isep+IIb, sm3, ly1, v1, infα, n1(106recR). After surgical resection, the patient was treated with additional adjuvant chemotherapy using CDDP and CPT-11. However,14 months later, mediastinal lymph node metastases appeared, and 21 months later, be died with pleuritis carcinomatosa. It is suggested that the morphological findings of this case showed the typical feature of submucosally invasive SmCC of the esophagus.

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