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PubMed1993

Carcinosarcoma of the esophagus: a report of two cases.

Among 137 cases of esophageal neoplasms surgically treated at Kobe City General Hospital from 1983 to 1990, there were two patients with a huge polypoid lesion identified as carcinosarcoma by light microscopic examination, both of whom underwent radical resection and esophagogastrostomy. Microscopic examination of the resected specimens revealed the tumors to be composed of carcinomatous and sarcomatous elements. Additional immunohistochemical examination disclosed keratin-positive cells in the carcinomatous element and vimentin-positive cells in the sarcomatous element. In case 1, keratin-positive cells were also found in the sarcomatous element, which suggested that the sarcomatous cells were derived from epithelial cells. Despite the huge size of the tumors, the depth of invasion to the esophageal wall was limited to the mucosal layer in case 1 and the submucosal layer in case 2, and there has been no evidence of recurrence in either case since surgery.

Aged↗
PubMed1991

Esophageal intubation for malignant fistulas.

Between April 1978 and December 1989 at the Endoscopy Division of the National Cancer Institute of Milan, 140 patients were intubated for esophageal neoplasms; 19 of these subjects underwent endoscopic intubation for malignant fistulas complicated by pneumonia and/or mediastinitis. The prostheses were tolerated well and enabled the restoration of oral nutrition. The mean survival was 4.7 months (range, 0.5-17 months). No major complications occurred. Tube dislodgement was observed in 2 cases (10.5%). Two patients died of causes that were not related to the procedure.

Aged↗
PubMed1997

Primary malignant melanoma of the esophagus. A case report.

A case of primary malignant melanoma of the esophagus has been reported. This rare entity accounts for less than 0.2% of all esophageal neoplasms. A polypoid, deep blue and tough tumour was present on endoscopic examination during which a few samples were taken. Microscopically melanotic tissue occupied the whole submucosa and scanty deposits of melanin pigment were dispersed. Positive immunohistochemical stain with HMB-45 antibody confirmed the diagnosis of malignant melanoma. The patient was admitted to the Oncological Center for resection of the tumour, which is the treatment of choice in such cases.

Esophageal Neoplasms↗
PubMed1975

Small cell epidermoid carcinoma of the esophagus. An oat-cell-like carcinoma.

A case of small cell anaplastic epidermoid carcinoma of the esophagus is reported. The morphology of this rare esophageal neoplasm simulates that of oat cell carcinoma. Four similar cases have been previously reported. The finding of epidermoid differentiation in two of these tumors, including the present one, raises considerable doubt that any are truly oat cell carcinomas of the esophagus. Although it is theoretically possible that an oat cell carcinoma may arise in the esophagus, there is as yet no conclusive evidence for the existence of such an entity.

Aged↗
PubMed1995

Small cell carcinoma of the esophagus. The Massachusetts General Hospital experience, 1978 to 1993.

Thirteen patients with small cell carcinoma of the esophagus were treated at the Massachusetts General Hospital between 1978 and 1993. These patients accounted for 1.6% of all patients with esophageal neoplasms seen at our institution during this period. Five patients presented with extensive disease while eight were noted to have limited disease at diagnosis. Seven patients were treated with primary chemotherapy while four patients received radiation therapy alone. No patient in this series underwent surgical resection. Four complete responses to treatment were observed although overall survival was only 7 months. One patient receiving chemotherapy, external beam radiation therapy, and endoesophageal brachytherapy is alive and well without evidence of disease 24 months from diagnosis.

Aged↗
PubMed1996

Chemotherapy for carcinoma of the esophagus: a comparison of evidence from meta-analyses of randomized trials and of historical control studies.

BACKGROUND: Chemotherapy (CT) has been used as an adjunct to local treatment (surgery or radiotherapy) in esophageal carcinoma. A meta-analysis of all published randomized clinical trials and historical control studies which have used cisplatinum-based combination CT was carried out to asses the effect of chemotherapy on survival for esophageal cancer. MATERIALS AND METHODS: A computer-based literature search was performed for the period from January 1988 to March 1995 using the index terms "Esophageal neoplasms' and "Chemotherapy'. The frame of reference was further narrowed to include only cisplatinum-based combination chemotherapy. Twelve randomized clinical trials (RCT) and eight historical control (HC) studies were included in the meta-analysis. RESULTS: In the overview of HC studies a highly significant reduction in odds of death with CT was observed (68% +/- 8% OR = 0.32, 95% CI 0.24-0.42). On the other hand, the overview of RCTs showed a relative reduction in odds of death for the CT group of 4.2% +/- 23.7% (OR = 0.96, 95% CI 0.75-1.22). CONCLUSIONS: There was a gross overestimation of treatment effect in the studies using HC as compared to RCTs, despite the use of cisplatinum-based chemotherapy in both groups. The meta-analysis of RCTs reveal no significant survival benefit from cisplatinum-based adjuvant/neoadjuvant chemotherapy in esophageal cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Carcinogenic effects of sequential administration of two nitrosamines in Fischer 344 rats.

The carcinogenic effects of sequential treatment of female F344 rats with two nitrosamines were studied. The animals received either methylethylnitrosamine (NMEA), a strong liver carcinogen, N-nitrosomethylaniline (NMA), a moderately strong esophageal carcinogen, or N-nitrosopyrrolidine, (NPyr), a weaker liver carcinogen. The sequentially treated groups were given NMEA followed by NMA and vice versa, NPyr followed by NMEA and vice versa. The dose and duration for each chemical in the sequentially treated groups were identical for the individual treatments. The animals were allowed to die or were killed when moribund. The animals surviving longer than 110 weeks were sacrificed. The NMEA-NPyr and NPyr-NMEA groups had a tumor spectrum characteristic for NMEA alone (a mixture of hepatic carcinomas and sarcomas with extensive metastases to the lungs). The survival was reduced in the NMEA-NPyr group compared to the NMEA alone group. The time to death of the NMA-NMEA group was not affected by the NMA treatment, but many of the animals had esophageal neoplasms. The NMEA-NMA group survival was reduced when compared to the NMEA alone group but the tumor spectrum was dominated by NMEA. The data indicate that when the target organ is the same, the effect of two nitrosamines is additive with the stronger carcinogen dominating the tumor spectrum. When the target organs are different, the initial exposure influences the tumor spectrum, although the treatment with the second nitrosamine enhances the tumorigenicity of the initial nitrosamine.

Animals↗
PubMed2003

Threshold for carcinogenicity of N-nitrosodiethylamine for esophageal tumors in rats.

In a study on 4080 rats by Peto et al. [Cancer Res. 51 (1991) 6415], esophageal neoplasms induced by N-nitrosodiethylamine (NDEA) were the tumors most clearly demonstrated to have a dose response from administration of the compound to male rats. However, they were unable to predict the shape of the dose-response curve at low doses. These data were reanalyzed in the present study for dose response on a logarithmic scale for dose. In contrast to the conclusion of Peto et al., the reanalysis shows a convincingly sharp threshold at 10(17.1) molecules/kg/day. This unequivocal threshold has substantial implications for risk assessment of chemical carcinogens.

Alkylating Agents↗
PubMed1982

Femoral and skull metastasis with hypercalcemia: occurrence with esophageal carcinoma without dysphagia.

The most common initial symptom of esophageal neoplasm is dysphagia. When metastasis occurs, it is most frequent to neighboring lymph nodes, mediastinum, or viscera, eg, the lungs and liver, and only infrequently to bones. Even less frequently do these metastases occur with hypercalcemia. A 59-year-old woman was initially seen with hypercalcemia and bone pain in the hip and leg, which subsequently proved to be the site of metastatic spread secondary to squamous cell carcinoma of the esophagus. Until her death, approximately four months after the diagnosis, she never experienced dysphagia, epigastric or substernal pain, or regurgitation.

Carcinoma, Squamous Cell↗
PubMed2003

Does a surgical antireflux procedure decrease the incidence of esophageal adenocarcinoma in Barrett's esophagus? A meta-analysis.

OBJECTIVE: The risk of adenocarcinoma of the esophagus is increased among those with Barrett's esophagus (BE). Whether the risk of cancer in the setting of BE can be decreased by a surgical antireflux procedure (SARP) is unclear. This study compared the reported incidence of esophageal adenocarcinoma in subjects with BE who underwent SARP with those with BE who had medical management. METHODS: We used MEDLINE to perform a meta-analysis of the English language literature published from 1966 through October 2001. We reviewed abstracts found with the search term "Barrett's esophagus" and the following: "adenocarcinoma," "esophageal neoplasm," "proton pump inhibitor," "fundoplication," or "antireflux procedure." Study entry criteria included 1) trial or cohort study with a report of cancer risk expressible in cancers per patient-year, 2) histologic confirmation of BE and any adenocarcinomas, and 3) adequate description of intervention (medical vs SARP). Data were abstracted by two reviewers using standardized forms. Subgroup comparisons were made using only medical management studies published in the last 5 yr. Multivariable regression controlling for subject age, country of origin, and BE length was performed. RESULTS: We reviewed 1247 abstracts, and 34 met the inclusion criteria. There were a cumulative 4678 patient-years of follow-up in the SARP group and 4906 patient-years in the medical group. The cancer incidence rate in the SARP group was 3.8 cancers/1000 patient-years, compared with 5.3 in the medical group (p=0.29). Similarly, there was no significant difference between cancer rates when comparing SARP with medical series reported in the last 5 yr (3.8/1000 patient-years vs 4.2/1000 patient-years, p=0.33). Multivariate analysis controlling for subject age, country of origin, and BE length did not alter these findings. CONCLUSION: The reported risk of adenocarcinoma in subjects with BE is low and not significantly decreased by a surgical antireflux procedure. Antireflux surgery in the setting of BE should not be recommended as an antineoplastic measure.

Adenocarcinoma↗
PubMed2005

[Reinterventions for complication and defect of coloesophagoplasty].

AIM OF THE STUDY: To report a series of 17 patients operated for a complication oesophagocoloplasty, with evaluation of therapeutic modalities, and both early and distant results. MATERIALS AND METHOD: From 1985 to 2003, 17 patients with a mean age of 50 years (range: 23-76) were reoperated after coloplasty pediculated on left superior colic vessels. Initial diseases were caustic ingestion (N=7), cancer (N=6), oesophageal perforation (N=2), gastric lymphoma (N=1) and oesotracheal fistula (N=1). Coloplasty has been performed as a first-intent procedure in 13 cases and as a second-intent procedure after failure of a previous operation in 4 cases. Nine patients were initially operated in another center and were subsequently referred in our unit. Complications needing reoperation were graft necrosis in 8 cases (47%) and stricture in 9 cases (53%). All patients with necrosis were reoperated within the 10 first postoperative days. RESULTS: Necroses were treated by complete (N=5) or partial (N=3) resection of the coloplasty. Strictures were treated by resection-reanastomosis (N=3), right ileocoloplasty (N=2), colic stricturoplasty (N=2), a free antebrachial flap (N=1) and a tubulized latissimus dorsi myocutaneous pedicled flap (N=1). The 30-day mortality rate was 12% (N=2) and the overall morbidity rate was 66%. All deaths occurred after reoperation for necrosis. Eleven patients (65%) kept or recovered digestive continuity (including the 9 with stenosis) and 8 (73%) eat normally. Four patients with transplant necrosis died before reestablishment. Four patients operated for necrosis died before restoration of digestive continuity and 2 patients are still awaiting restoration. CONCLUSION: Use of colon as an oesophageal substitute is risky. Reoperations for stenosis allows satisfactory oral feeding, while reoperation for necrosis is associated with both high early mortality and a low rate of restoration or digestive continuity. This later requires a range of complex surgical procedures.

Adult↗
PubMed2004

Risk of extra-oesophageal malignancies and colorectal cancer in Barrett's oesophagus and gastro-oesophageal reflux.

BACKGROUND: The relationship between Barrett's oesophagus and colorectal cancer and other extra-oesophageal malignancies (EOM) has been a matter of controversy. These relationships have therefore been examined in a prospective study design in the General Practice Research Database. METHODS: Cohorts of patients having Barrett's oesophagus (n=1677), oesophagitis (n=6392), and simple reflux (n=6328), and a standard reference cohort representing the general population in the UK (n=13,416) were selected. The last three cohorts were matched to the Barrett's cohort by general practice, age and sex. Incident outcomes occurring beyond the first year of the follow-up were used for analyses. Hazard ratios and 95% confidence intervals were calculated using Cox's proportional hazards regression. The associations with cataract and oesophageal cancer were explored for comparison. RESULTS: Incident cases of 567 EOM (including 74 colorectal cancers), 448 cataract and 43 oesophageal cancers were used in the final analysis. The relative risks for colorectal cancer compared to the standard reference cohort were 1.16 (0.42-3.21) in the Barrett's cohort, 1.39 (0.76-2.54) in the oesophagitis cohort, and 0.93 (0.45-1.90) in the simple reflux cohort. The corresponding relative risks in the Barrett's cohort were 1.29 (0.90-1.85), 1.60 (1.10-2.32), and 10.56 (5.07-21.99) for EOM, cataract and oesophageal cancer, respectively. CONCLUSIONS: The risk of colorectal cancer was not higher in any of the Barrett's oesophagus, oesophagitis, or reflux cohorts compared to the general population. The explanations for the modest increase in the risk of EOM and cataract in the above cohorts are unclear but they may be mediated by ascertainment bias or shared risk factors.

Aged↗
PubMed1989

Dukes A carcinoma after colonic interposition for oesophageal stricture.

The management of caustic and peptic oesophageal strictures refractory to medical treatment and repeated dilatations continues to be a challenge. Colonic interposition with subtotal oesophagectomy is felt by many surgeons to be the best treatment. Complications in the short and long term are, however, frequent. We report a case of a colonic carcinoma originating in a colonic interposition and growing up into the oesophageal remnant.

Adenocarcinoma↗