Abstract
Only a few cases of esophageal granulocyte-colony-stimulating-factor (G-CSF)–producing esophageal carcinosarcoma are reported, and patients with G-CSF–producing tumors are typically considered to have poor prognosis. An 89-year-old man was examined for low-grade fever and dysphagia. Chest computed tomography revealed a huge 80-mm tumor on the thoracic esophagus without direct invasion to surrounding organs. Esophagogastroduodenoscopy (EGD) showed a huge mass occupying the esophageal lumen with a superficial flat lesion. Histopathological examination revealed that the tumor was composed of bizarre giant cells and pleomorphic spindle cells with hyperchromatic nuclei. Laboratory data showed aberrant elevation of leukocyte and neutrophil counts and G-CSF levels. The tumor was finally diagnosed as a G-CSF-producing esophageal carcinosarcoma, stage II (T2N0M0, Union for International Cancer Control-TNM Classification of Malignant Tumors, 8th edition). Considering his general condition, we performed palliative radiotherapy (45 Gy/15 fr) alone after consultation with surgeons and radiation oncologists. Follow-up EGD demonstrated the disappearance of the tumor, and the histological assessment of biopsy specimens confirmed no evidence of malignancy. The leukocyte count and G-CSF levels decreased within normal range. This is a very rare case of G-CSF-producing esophageal carcinosarcoma in which a pathologically complete response was achieved using palliative radiotherapy alone.
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References
Iyomasa S, Kato H, Tachimori Y, et al. Carcinosarcoma of the esophagus: a twenty-case study. Jpn J Clin Oncol. 1990;20:99–106.
Matsutani T, Nomura T, Hagiwara N, et al. A case of carcinosarcoma of the esophagus detected on fluorodeoxyglucose positron emission tomography. J Nippon Med Sch. 2014;81:401–5.
Ogasawara N, Tamura Y, Funaki Y, et al. Rapidly growing esophageal carcinosarcoma reduced by neoadjuvant radiotherapy alone. Case Rep Gastroenterol. 2014;8:227–34.
Sanada Y, Hihara J, Yoshida K, et al. Esophageal carcinosarcoma with intramural metastasis. Dis Esophagus. 2006;19:119–31.
Patricia S, Saikat D, Rajesh B, et al. Rare cause of stricture esophagus-sarcoma: a case report and review of the literature. Case Rep Gastrointest Med. 2011; 2011:192423.
Kobayashi S, Nagata Y, Tokai H, et al. Multidisciplinary therapy for granulocyte-colony-stimulating factor producing carcinosarcoma of the esophagus: report of a case. Clin Case Rep. 2015;3:681–5.
Ota S, Kato A, Kobayashi H, et al. Monoclonal origin of an esophageal carcinosarcoma producing granulocyte-colony stimulating factor: a case report. Cancer. 1998;82:2102–11.
Maejima K, Watanabe M, Komine O, et al. Granulocyte-colony stimulating factor-producing esophageal carcinosarcoma: a case report. Esophagus. 2007;4:117–20.
Sasaki K, Natsugoe S, Higashi M, et al. Esophageal carcinosarcoma with granulocyte colony-stimulating factor: a case report. Esophagus. 2007;4:129–34.
Miyamoto K, Shibata S, Kawasaki H. Carcinosarcoma of the esophagus producing granulocyte-colony stimulating factor: report of a case. Esophagus. 2008;5:171–5.
Cha RR, Jung WT, Oh HW, et al. A case of metachronous development of esophageal squamous cell carcinoma in the patient with esophageal carcinosarcoma. Korean J Gastroenterol. 2014;64:364–9.
Ji F, Xu YM, Xu CF. Endoscopic polypectomy: a promising therapeutic choice for esophageal carcinosarcoma. World J Gastroenterol. 2009;15:3448–50.
Adan AK, Long AE, Weldon CB, et al. Esophageal carcinosarcoma. J Gastrointest Surg. 2001;5:414–7.
Akagi I, Miyashita M, Makino H, et al. So-called carcinosarcoma of the esophagus: report of a case. J Nippon Med Sch. 2008;75:171–4.
Iascone C, Barreca M. Carcinosarcoma and pseudosarcoma of the esophagus: two names, one disease–comprehensive review of the literature. World J Surg. 1999;23:153–7.
Zhang B, Xiao Q, Yang D, et al. Spindle cell carcinoma of the esophagus: a multicenter analysis in comparison with typical squamous cell carcinoma. Medicine (Baltimore). 2016;95:e4768.
Wang L, Lin Y, Long H, et al. Esophageal carcinosarcoma: a unique entity with better prognosis. Ann Surg Oncol. 2013;20:997–1004.
Penniment MG, De Ieso PB, Harvey JA, et al. Palliative chemoradiotherapy versus radiotherapy alone for dysphagia in advanced oesophageal cancer: a multicentre randomised controlled trial (TROG 03.01). Lancet Gastroenterol Hepatol. 2018;3:114–24.
Bradley JD, Paulus R, Komaki R, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015;16:187–99.
Postow MA, Callahan MK, Barker CA, et al. Immunologic correlates of the abscopal effect in a patient with melanoma. N Engl J Med. 2012;366:925–31.
Kingsley DP. An interesting case of possible abscopal effect in malignant melanoma. Br J Radiol. 1975;48:863–6.
Bruton Joe M, Truong PT, et al Abscopal effect after palliative radiation therapy for metastatic adenocarcinoma of the esophagus. Cureus 2018; 10(8):e3089.
Takahashi Y, Yasui T, Tamari K, et al. Radiation enhanced the local and distant anti-tumor efficacy in dual immune checkpoint blockade therapy in osteosarcoma. PLoS One. 2017;12:e0189697.
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Keiichi Kimura, Yoshito Hayashi, Keisuke Otani, Yoshiki Tsujii, Hideki Iijima, Fumiaki Isohashi, Kazuhiko Ogawa, and Tetsuo Takehara declare that they have no conflict of interest.
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Kimura, K., Hayashi, Y., Otani, K. et al. Esophageal carcinosarcoma that disappeared pathologically by palliative radiotherapy alone. Clin J Gastroenterol 12, 247–253 (2019). https://doi.org/10.1007/s12328-019-00933-7
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DOI: https://doi.org/10.1007/s12328-019-00933-7