Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

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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.

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We herein report a case of a spontaneous fistula that developed from a carcinoma of the sigmoid colon that discharged through the umbilicus. A 72-year-old man was referred to our hospital for an examination of a foul odorous and purulent umbilical discharge. Six months prior to admission he complained of enuresis and ischuria for cystitis at the urological clinic of our hospital. The preoperative computed tomography and colonoscopy findings suggested a colo-umbilical fistula arising from the carcinoma of the sigmoid colon. At laparotomy, a 8-cm diameter mass, involving the anterior abdominal wall and the sigmoid colon, was found and it closely adhered to the upper aspect of the urinary bladder. An en bloc resection was thus performed. Its specimen showed an Borrmann 2-liked carcinoma of the sigmoid colon with an orifice of the colo-umbilical fistula, which was composed of a inflammatory tissue and no neoplastic cells were detected. This is the first case report of a spontaneous colo-umbilical fistula caused by a perforation of colon carcinoma, which demonstrated a pus discharge from the umbilicus. Carcinoma of the colon should thus be considered as a cause of an unexplained umbilical discharge.

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