A Case of Concurrent double Cancer Consisting of a So-called Carcinosarcoma of the Ulcero-infiltrative Type of the Esophagus and early Gastric Cancer

Abstract

So-called carcinosarcoma of the esophagus is a rare tumor which is usually of the polypoid type. We experienced an extremely rare case of double cancer consisting of ulcerative and infiltrative type carcinosarcoma with concurrent gastric cancer. The patient was a 54 year-old male whose main complaint was dysphagia. Ulcerative and infiltrative esophageal cancer was found in the lower thoracic and abdominal esophagus, and gastric cancer in the greater curvature of the gastric angle. In a preoperative biopsy, squamous cell carcinoma was diagnosed in the esophagus, and total thoracic esophagectomy and total gastrectomy were performed. Pathological findings showed sarcoma-like proliferation of spindle cells in the esophageal tumor which was positive for keratin staining and negative for vimentin staining. So-called carcinosarcoma was diagnosed. No remote metastasis was found during the operation, but after 1 year and 7 months, right solitary lung metastasis and right cervical lymph node metastasis were observed. The lung tumor was resected and radiotherapy was performed, but the patient died 2 years and 6 months after the initial operation. From a study of reports of so-called carcinosarcoma of the esophagus in Japan, it was evident that lymph node metastasis of tumors with a small diameter is found from the shallow invasion stage, and recurrences often occur in the cervical lymph nodes. Multidisciplinary treatment, mainly consisting of total thoracic esophagectomy with consideration given to lymph node dissection in the cervical region, is required.