Esophageal Sarcoma
Introduction
Introduction to esophageal sarcoma Esophageal sarcoma (esophagealsarcoma) is a malignant tumor derived from mesenchymal tissue, accounting for about 8% of digestive sarcoma and about 0.5% of esophageal malignant tumors. According to histological features, esophageal sarcoma includes leiomyomas, fibrosarcoma, rhabdomyosarcoma, osteosarcoma and Kaposi sarcoma in immunodeficient patients. Among them, fibrosarcoma is the most common, accounting for half of esophageal sarcoma, and there are two types of esophageal sarcoma: polyps and infiltrates. Polyposis is more common in clinical practice, and its tumor volume is large, protruding into the esophageal lumen, developing and metastasizing later, and the resection rate is high. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: Esophageal cancer Esophageal hiatus hernia
Cause
Esophageal sarcoma etiology
Causes:
The cause is not clear.
Pathogenesis:
Most of the sarcoma tissue is polypoid-like into the esophageal lumen. The surface of the esophagus is often covered with atrophic squamous epithelium. The tumors vary in width and width. The length of the pedicle is connected to the esophageal wall. The tumor tissue is mainly located in the mucosal polypoid mass. In some cases, part of the tumor tissue is mainly distributed in the submucosa and muscle layer. The infiltrative type is rare. The tumor tissue is located in the esophageal wall, showing invasive growth, the esophageal wall is thickened, the surface is shallow or ulcer-free, and the musculocutaneous texture is smooth. Solid, while fibrous sarcoma and rhabdomyosarcoma texture is slightly soft, the surface can have a false envelope, esophageal sarcoma is most common in the lower part of the esophagus, followed by the middle section, the upper part rarely occurs.
Microscopic examination of leiomyosarcoma tissue is bundled or strip-like. It consists of smooth muscle cells interlaced by criss-crossing. The cytoplasm is rich, lightly stained with red, and the nucleus is rod-shaped. It has a heterogeneity of light and heavy, and generally differentiates well. A small number of mitotic figures can be seen. The tumor tissue infiltrates the submucosa and muscle layer, but there is very little lymph node metastasis.
The pathology of esophageal rhabdomyosarcoma is divided into three types: polymorphic follicular type, acinar type and embryo type. Polymorphic follicular type is common in the elderly, acinar type is more common in young people, and embryo type is mainly in infants. .
Prevention
Esophageal sarcoma prevention
At the time of diagnosis, the possibility of esophageal malignancy must be considered for identification and exclusion. Mucosal biopsy should not be performed during esophagoscopy to avoid damage and mucosal adhesion to the tumor, which may hinder subsequent surgical removal. Surgery should be performed with good results, small trauma and less complications of extramucosal tumor removal. The partial esophagectomy should not be performed lightly.
Complications with less extramucosal tumor removal should not be performed with partial esophagectomy.
Complication
Esophageal sarcoma complications Complications esophageal cancer esophageal hiatus hernia
1, the disease often occurs with some concomitant diseases, including: esophageal hiatus hernia, diverticulum, esophageal hemangioma and achalasia.
2, esophageal leiomyomas complicated with postoperative esophageal fistula, pulmonary infection, anastomotic stenosis cases have also been reported, but the general situation is easy to control.
Symptom
Esophageal sarcoma symptoms Common symptoms Loss of appetite, severe pain, difficulty swallowing
80% of patients have different dysphagia, but the disease is longer. Other symptoms include foreign body sensation after the sternum, burning sensation, etc. Patients with esophageal leiomyosarcoma may also experience severe pain in the upper abdomen.
Examine
Examination of esophageal sarcoma
Histopathological examination is the main basis for diagnosis.
1. Chest flat: for the large polypoid filling defect in the esophageal lumen, the lumen is fusiform, and the mediastinum can be widened.
2. Esophageal barium angiography : See the curved upper edge of the tumor, the uneven distribution of tincture in the lesion, the tumor pedicle in the tangential position, showing mucosal destruction and irregular filling defects of the esophageal wall.
Clinically common leiomyosarcoma can have three images:
1 esophageal leiomyomas-like X-ray signs.
2 esophageal cancer-like X-ray signs.
3 mediastinal tumors in the mediastinum.
3. Esophagoscopy examination See the cavity mass, can have pedicle, mucous membrane erosion, rough, crisp, easy to contact with bleeding, but also erosion, necrotic tissue.
4. CT and MRI examinations are similar to esophageal cancer.
Diagnosis
Diagnosis and diagnosis of esophageal sarcoma
The final diagnosis relies on postoperative pathological diagnosis.
There are three major similarities and differences between this disease and esophageal cancer.
1. Patients with dysphagia generally have different degrees of dysphagia. Because the disease progresses slowly, the symptoms are light and heavy, and the medical history is longer. The dysphagia of esophageal cancer is generally progressive, the disease progresses rapidly, and the medical history is relatively short.
2. The size of the esophageal leiomyosarcoma is more concealed, and it is difficult to find it early. When the patient has symptoms of swallowing obstruction, the tumor is often very large.
3. Growth mode The size of the tumor is not parallel with the symptoms of dysphagia. This is because the disease mainly grows out of the esophageal cavity and less invades the esophageal mucosa. Unlike esophageal cancer, it is mainly esophageal mucosal lesions. Therefore, clinical Early detection of esophageal leiomyosarcoma is difficult.
