Clinicopathological Features of Esophageal Carcinosarcoma Treated with Surgery: A Series of Nine Cases

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INTRODUCTION: Esophageal carcinosarcoma (ECS) is a rare malignant tumor composed of both carcinomatous and sarcomatous components. Owing to its rarity, the clinicopathological characteristics, optimal treatment strategies, and prognostic factors of ECS remain poorly understood. This study reported the clinicopathological features and treatment outcomes of surgically treated ECS. CASE PRESENTATION: Between 1999 and 2019, 713 patients underwent surgery for thoracic esophageal malignancies at Kurume University Hospital. Among them, 9 patients (1.3%) were diagnosed with ECS. All patients were male, with a median age of 65 years (range, 58-76 years). Preoperative endoscopic biopsy correctly diagnosed ECS in only 1 patient, while the majority were initially diagnosed as squamous cell carcinoma. Recurrence occurred in 5 patients, including local recurrence, lymph node metastasis, and distant metastasis. The 5-year overall survival rate was 22.2%, reflecting a generally poor prognosis. Histopathological examination revealed that the histological component identified at sites of lymphatic invasion in the primary tumor was consistent with those observed in metastatic lymph nodes. CONCLUSIONS: ECS may exhibit aggressive biological behavior that is not adequately reflected by tumor depth alone. Surgery alone may be insufficient for disease control in some patients. Further studies are required to clarify the biological characteristics of ECS and to establish optimal treatment strategies.

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