A rare case of bipartite combined tumour of the oesophagus
Abstract Background Bipartite combined oesophageal tumours are an exceedingly rare entity and much less is known about the natural history of these tumours following curative surgery. The authors present a case of a bipartite combined oesophageal tumour comprising of sarcomatoid carcinoma and small...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-05-01
|
| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12957-019-1623-7 |
| _version_ | 1819104330674864128 |
|---|---|
| author | Nicholette Goh Danson Xue Wei Yeo Sanghvi Kaushal Amitbhai Myint Oo Aung Yong Howe Ho Aaryan Nath Koura Jaideepraj Rao |
| author_facet | Nicholette Goh Danson Xue Wei Yeo Sanghvi Kaushal Amitbhai Myint Oo Aung Yong Howe Ho Aaryan Nath Koura Jaideepraj Rao |
| author_sort | Nicholette Goh |
| collection | DOAJ |
| description | Abstract Background Bipartite combined oesophageal tumours are an exceedingly rare entity and much less is known about the natural history of these tumours following curative surgery. The authors present a case of a bipartite combined oesophageal tumour comprising of sarcomatoid carcinoma and small cell carcinoma with early postoperative recurrence. Case presentation A 63-year-old Chinese male with a smoking history presents with hemoptysis on a background of dysphagia and odynophagia for 1 month. An endoscopic evaluation found an exophytic oesophageal tumour with contact bleeding for which biopsy of this lesion returned as a malignant high-grade tumour where immunohistochemistry staining was unable to establish the lineage of the tumour. Differential diagnoses include sarcomatoid carcinoma and malignant undifferentiated sarcoma. With the provisional diagnosis of a high-grade oesopheageal sarcoma, the patient underwent minimally invasive McKeown’s oesophagectomy. Final histological assessment was pT1bN0 with two histological types of malignancy within a single tumour—70% poorly differentiated spindle cell squamous carcinoma and small cell carcinoma. He was planned for adjuvant chemotherapy in view of the small cell carcinoma component after the resolution of the postoperative infective collections. A computed tomographic scan performed 4 months postoperatively demonstrated metastasis to the lung, pleura, thoracic nodes and liver. Biopsy of the largest lung nodule confirmed small cell neuroendocrine carcinoma with features similar to the small cell carcinoma component in the prior oesophagectomy specimen. He was thereafter initiated on palliative chemotherapy aimed at three weekly carboplatin and etoposide aimed at a total of 4 cycles with peglasta support. Etoposide was stopped during the first cycle due to asymptomatic bradycardia. The regime was then converted to carboplatin with irinotecan for 5 cycles. Repeat computed tomographic scan performed 3 weeks after the completion of chemotherapy showed a complete response of lung and liver metastasis and no evidence of local recurrence or distant metastasis. Conclusion The management of bipartite combined oesophageal tumours should be guided by its more aggressive component. Bipartite combined oesophageal tumours with a small cell carcinoma component are believed to demonstrate aggressive tumour biology likened to that of primary oesophageal small cell carcinoma. Preoperative confirmation of a combined tumour may be challenging, and biopsy results may only yield one of the two components. The more aggressive component is usually a small cell carcinoma, for which the mainstay of therapy is platinum-based chemotherapy rather than surgery. |
| first_indexed | 2024-12-22T02:04:39Z |
| format | Article |
| id | doaj.art-bfd63b7341964b21ba9ea9df21454ad1 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-12-22T02:04:39Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-bfd63b7341964b21ba9ea9df21454ad12022-12-21T18:42:33ZengBMCWorld Journal of Surgical Oncology1477-78192019-05-011711710.1186/s12957-019-1623-7A rare case of bipartite combined tumour of the oesophagusNicholette Goh0Danson Xue Wei Yeo1Sanghvi Kaushal Amitbhai2Myint Oo Aung3Yong Howe Ho4Aaryan Nath Koura5Jaideepraj Rao6Department of General Surgery, Tan Tock Seng HospitalDepartment of General Surgery, Tan Tock Seng HospitalDepartment of General Surgery, Tan Tock Seng HospitalDepartment of General Surgery, Tan Tock Seng HospitalDepartment of Pathology, Tan Tock Seng HospitalDepartment of General Surgery, Tan Tock Seng HospitalDepartment of General Surgery, Tan Tock Seng HospitalAbstract Background Bipartite combined oesophageal tumours are an exceedingly rare entity and much less is known about the natural history of these tumours following curative surgery. The authors present a case of a bipartite combined oesophageal tumour comprising of sarcomatoid carcinoma and small cell carcinoma with early postoperative recurrence. Case presentation A 63-year-old Chinese male with a smoking history presents with hemoptysis on a background of dysphagia and odynophagia for 1 month. An endoscopic evaluation found an exophytic oesophageal tumour with contact bleeding for which biopsy of this lesion returned as a malignant high-grade tumour where immunohistochemistry staining was unable to establish the lineage of the tumour. Differential diagnoses include sarcomatoid carcinoma and malignant undifferentiated sarcoma. With the provisional diagnosis of a high-grade oesopheageal sarcoma, the patient underwent minimally invasive McKeown’s oesophagectomy. Final histological assessment was pT1bN0 with two histological types of malignancy within a single tumour—70% poorly differentiated spindle cell squamous carcinoma and small cell carcinoma. He was planned for adjuvant chemotherapy in view of the small cell carcinoma component after the resolution of the postoperative infective collections. A computed tomographic scan performed 4 months postoperatively demonstrated metastasis to the lung, pleura, thoracic nodes and liver. Biopsy of the largest lung nodule confirmed small cell neuroendocrine carcinoma with features similar to the small cell carcinoma component in the prior oesophagectomy specimen. He was thereafter initiated on palliative chemotherapy aimed at three weekly carboplatin and etoposide aimed at a total of 4 cycles with peglasta support. Etoposide was stopped during the first cycle due to asymptomatic bradycardia. The regime was then converted to carboplatin with irinotecan for 5 cycles. Repeat computed tomographic scan performed 3 weeks after the completion of chemotherapy showed a complete response of lung and liver metastasis and no evidence of local recurrence or distant metastasis. Conclusion The management of bipartite combined oesophageal tumours should be guided by its more aggressive component. Bipartite combined oesophageal tumours with a small cell carcinoma component are believed to demonstrate aggressive tumour biology likened to that of primary oesophageal small cell carcinoma. Preoperative confirmation of a combined tumour may be challenging, and biopsy results may only yield one of the two components. The more aggressive component is usually a small cell carcinoma, for which the mainstay of therapy is platinum-based chemotherapy rather than surgery.http://link.springer.com/article/10.1186/s12957-019-1623-7Oesophageal cancerSmall cell carcinomaCombined tumours |
| spellingShingle | Nicholette Goh Danson Xue Wei Yeo Sanghvi Kaushal Amitbhai Myint Oo Aung Yong Howe Ho Aaryan Nath Koura Jaideepraj Rao A rare case of bipartite combined tumour of the oesophagus World Journal of Surgical Oncology Oesophageal cancer Small cell carcinoma Combined tumours |
| title | A rare case of bipartite combined tumour of the oesophagus |
| title_full | A rare case of bipartite combined tumour of the oesophagus |
| title_fullStr | A rare case of bipartite combined tumour of the oesophagus |
| title_full_unstemmed | A rare case of bipartite combined tumour of the oesophagus |
| title_short | A rare case of bipartite combined tumour of the oesophagus |
| title_sort | rare case of bipartite combined tumour of the oesophagus |
| topic | Oesophageal cancer Small cell carcinoma Combined tumours |
| url | http://link.springer.com/article/10.1186/s12957-019-1623-7 |
| work_keys_str_mv | AT nicholettegoh ararecaseofbipartitecombinedtumouroftheoesophagus AT dansonxueweiyeo ararecaseofbipartitecombinedtumouroftheoesophagus AT sanghvikaushalamitbhai ararecaseofbipartitecombinedtumouroftheoesophagus AT myintooaung ararecaseofbipartitecombinedtumouroftheoesophagus AT yonghoweho ararecaseofbipartitecombinedtumouroftheoesophagus AT aaryannathkoura ararecaseofbipartitecombinedtumouroftheoesophagus AT jaideeprajrao ararecaseofbipartitecombinedtumouroftheoesophagus AT nicholettegoh rarecaseofbipartitecombinedtumouroftheoesophagus AT dansonxueweiyeo rarecaseofbipartitecombinedtumouroftheoesophagus AT sanghvikaushalamitbhai rarecaseofbipartitecombinedtumouroftheoesophagus AT myintooaung rarecaseofbipartitecombinedtumouroftheoesophagus AT yonghoweho rarecaseofbipartitecombinedtumouroftheoesophagus AT aaryannathkoura rarecaseofbipartitecombinedtumouroftheoesophagus AT jaideeprajrao rarecaseofbipartitecombinedtumouroftheoesophagus |