Oesophageal carcinosarcoma

Dropbox link to some articles and case serieshttps://www.dropbox.com/sh/b9pqlmckxq99m0d/AAAVfWmxZmiJO4VElST1ZNRka?dl=0

Report sequence1 Authorised 11/11/2015 11:55

ByDr T Bracey CELLPATH (Dr Bracey) PC

NATURE OF SPECIMEN: 2WW

1. Biopsy of oesophagus 17cm.

2. Anterior wall oesophagus 15cm.

3. Post cricoid.

CLINICAL DETAILS:

Oesophageal cancer ?SCC anterior wall oesophagus at 17cm (Previously thought to be sarcoma.) Please confirm this is not sarcoma. FAO: Dr Tim Bracey.

GROSS DESCRIPTION:

1. Four biopsies, the largest 7 mm and the smallest 4 mm.

S4 NSW 1B JS/KW

2. Two biopsies larger 4 mm and the smallest 2 mm together with fragments 2 mm in diameter, ? survive processing.

S2+ NSW 1B JS/KW

3. One biopsy 4 x 4 x 3 mm.

S1 NSW 1B JS/KW

HISTOLOGY:

1. Fragments of high grade malignant neoplasm showing an abrupt distinction between a malignant epithelioid and mesenchymal elements. The spindle cell element is arranged in fascicles, with focal necrosis and frequent mitoses including atypical forms. There is no heterologous differentiation. The epithelioid component is predominantly large cell undifferentiated, but focally shows squamous differentiation. There is no definite surface epithelium or dysplasia sampled. The invasive epithelial component co-expresses MNF116, CK5 and p63. The spindle cell component is negative for the same epithelial markers and muscle markers (desmin, caldesmon and myogenin). The MIB-1 proliferation index is 13% in the epithelial component and 8% in the spindle cell areas.

The features are of oesophageal carcinosarcoma (a malignant neoplasm showing mixed epithelial and mesenchymal differentiation). From a management perspective, this can be treated as high grade squamous cell carcinoma as the epithelial component of this malignancy will confer a tendency to lymph node metastasis. The literature suggests that although carcinosarcoma may present at an earlier stage than carcinoma (due to rapid intraluminal growth), prognosis is worse than conventional SCC (even in T1 tumours) due to the higher rate of haematogenous metastasis of the mesenchymal component.

2-3. Biopsies of oesophageal and hypopharyngeal squamous mucosa showing no evidence of dysplasia or malignancy.

Conclusion

1.Oesophageal biopsies 17cm - carcinosarcoma (see text)

2-3. Postcricoid and 15cm biopsies - no dysplasia or malignancy

Reported by:Dr Tim Bracey using speech recognition

My colleague Dr Smith concurs

Oesophageal carcinosarcoma