Rapidly growing carcinosarcoma of the esophagus following definitive chemoradiotherapy: A case report and the literature review

• Published in: International journal of surgery case reports 2022-05, Vol.94, p.107116-107116, Article 107116
• Main Authors: Yamauchi, Takuro, Taniyama, Yusuke, Fujishima, Fumiyoshi, Sasano, Hironobu, Unno, Michiaki, Kamei, Takashi
• Format: Article
• Language: English
• Subjects: Carcinosarcoma; Case Report; Chemoradiotherapy; Esophagus; Salvage surgery; Spindle cell carcinoma
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107116

Esophageal carcinosarcoma is a rare malignancy composed of both carcinoma and sarcoma-like spindle cells. This tumor is usually diagnosed before treatment due to its unique macroscopic appearance but accurate diagnose is difficult even via biopsy if the sarcomatous component is small. Herein, we report a rare case of esophageal carcinosarcoma showing rapid growth after definitive chemoradiotherapy. A 65-year-old man was diagnosed with locally advanced esophageal squamous cell carcinoma with lymph node metastasis. Following definitive chemoradiotherapy, the primary tumor and metastatic lymph nodes were markedly reduced. However, at 14 weeks after treatment, an ulcerative lesion appeared at the site of the primary tumor and was clinically interpreted as residual cancer. The tumor rapidly grew in a short period of time and new metastatic lesions were clinically detected in the supraclavicular lymph nodes. Salvage esophagectomy was immediately performed and histopathological examination of the resected specimen revealed that the tumor was largely composed of sarcomatous spindle cells harboring the histological transition from squamous cell carcinoma. The final diagnosis was esophageal carcinosarcoma. Due to its characteristics, esophageal carcinosarcoma may occasionally get diagnosed as squamous cell carcinoma by endoscopic biopsy and chemoradiotherapy be performed for latent sarcomatous components unintentionally. There are only a few reports of esophageal carcinosarcoma treated with chemoradiotherapy, with its safety and efficacy not fully verified. In cases of rapidly growing tumors following chemoradiotherapy, carcinosarcoma should be considered as one of the differential diagnoses, warranting prompt surgical procedures. •We report a rare case of esophageal carcinosarcoma treated with CRT.•The diagnosis on biopsy before treatment was squamous cell carcinoma.•The tumor rapidly grew after CRT and salvage surgery was immediately performed.•CRT may be unintentionally given for patients with latent carcinosarcoma.•In such cases, CRT may be ineffective and surgery should be performed immediately.