Other malignant tumors of the esophagus
Introduction
Introduction to other malignant tumors of the esophagus The most common esophageal malignant tumor is squamous cell carcinoma, which is esophageal cancer, accounting for more than 95% of all cancers. Other malignant tumors are less than 5%. It is rare and widespread in clinical practice, generally including epithelial tumors and interstitial origin. 4 types of tumors, lymphoid tumors and metastases. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal cancer
Cause
Causes of other malignant tumors of the esophagus
The cause is not clear.
Prevention
Esophageal malignant tumor prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Esophageal other malignant tumor complications Complications Esophageal cancer
Gastroesophageal reflux symptoms, post-sternal pain.
Symptom
Esophageal other malignant tumor symptoms Common symptoms Cyst malignant brain metastasis Squamous epithelial pain Abdominal esophagus mucosa exfoliation weight loss weight loss varicose veins
Other rare malignant tumors of the esophagus are similar to esophageal squamous cell carcinoma as dysphagia and pain, and late stage is cachexia. The degree of progression varies with tumor tissue.
Esophageal adenocarcinoma
Reported in the literature, esophageal adenocarcinoma accounts for 0.46% to 1.5% of esophageal malignancies, and the incidence has increased in recent years. Except in the esophageal wall or ectopic gastric mucosa, 85% of foreign literature reports from Barrett's esophagus because 8% to 10% of Barrett's esophagus develops into cancer. Domestic Barrett's esophagus is rarely reported in the literature. Esophageal adenocarcinoma is derived from esophageal mucosal pluripotent stem cells. This view may explain its incidence, mainly manifesting dysphagia, body weight. Decreased and gastroesophageal reflux symptoms such as heartburn, upper sternal pain, etc., the incidence of lymph node metastasis is as high as 50% to 70%, and its prognosis is worse than squamous cell carcinoma.
2. Esophageal carcinosarcoma
Carcinosarcoma is composed of cancer and sarcoma. It can also be found in the uterus, breast, thyroid, pharynx and other parts. Esophageal carcinosarcoma is rare. It is less than 1% of esophageal malignant tumors. The growth site is in the esophagus. More, the symptoms are mainly dysphagia, but because it is a pedicled tumor protruding into the cavity, does not affect the entire esophagus, so the difficulty of swallowing is mild, the progress is slow, late post sternal discomfort and pain X-ray esophageal barium meal is a typical endoluminal mass, and the esophageal lumen of the filling defect is obviously dilated. It is characterized by polyp type and infiltrative type. It is more common in polyp type, and the surface of the tumor is covered with atrophic squamous epithelium, or There are erosions, the mucosa at the joint of the pedicle and the esophagus is rough and uneven, and there are erosions. The sarcoma components (fibrosarcoma, leiomyosarcoma or fibroblastoma, etc.) can be seen in the polyp or nodular mass, which accounts for the tumor volume. For the most part, only 15% of sarcoma penetrates the muscle layer, and the cancer component is confined to the basal part of the esophageal mucosa of the pedicle. It is connected to the sarcoma component and is not mixed. A few cancers are mixed with sarcoma components, but both No transitional transition changes, most of the cancer is early carcinoma in situ or early invasive carcinoma, but also invading the muscular layer, but it is rare to invade the wall, lymph node metastasis is rare, such as metastasis is found to be part of the squamous cell carcinoma, the prognosis is better. Organizational genesis has a dual source of Virchow, Schild et al., saying that the tumors from the two tissues meet together as a collision tumor, or that both the cancer and the sarcoma are from the same embryonic stem cell, and later differentiate into two different types. Tissue, it is called a combination tumor, and some scholars believe that the primary sarcoma component, adjacent esophageal mucosa epithelium stimulated by it and cancerous, called synthesis tumor (composition tumor).
3. Esophageal sarcoma occurs in tumors of the mesenchymal tissue
Contains esophageal fibrosarcoma, leiomyosarcoma, rhabdomyosarcoma and angiosarcoma, the incidence of which accounts for 0.1% to 0.5% of esophageal malignancies, the volume of sarcoma is large, pedicled polypoid, invasive Fibrosarcoma is derived from fibroblasts of mesenchymal tissue and grows slowly, but is prone to hematogenous metastasis; leiomyosarcoma is derived from smooth muscle cells or cells that differentiate into smooth muscle; rhabdomyosarcoma is derived from skeletal muscle cells or mesenchymal cells that differentiate into skeletal muscle. Cells; angiosarcoma derived from vascular endothelial cells, generally sarcoma texture is slightly soft, the surface can have a pseudo-envelope and smooth muscle tumor texture is solid, mostly occurs in the 50 to 60 years old, the elderly, male incidence is more common, but young It can also occur in humans. The lower esophagus of esophageal sarcoma is the most common, the middle part is second, and the upper part is rare. The clinical symptoms are mainly dysphagia of different degrees, but the symptoms are longer, the progressive obstruction is milder, X-ray signs and esophagus Squamous cell carcinoma is similar, generally slower in metastasis, sensitive to radiation, and high in surgical resection rate.
4. Esophageal small cell carcinoma (oat cell tumor)
The incidence is low, reported in the literature as 1% to 2.4%, APUD cells originating from the foregut, most of the cancer tissues have argyrophilic cytoplasm, cells contain neurosecretory granules, and biochemical assays have increased ACTH activity in cancer tissues, but There are no reports of concurrent ectopic endocrine dysfunction syndrome. The histological classification is: 1 pure oat cell type: similar to lung oat cell carcinoma, the cells are small round or elliptical, with little cytoplasm or naked nuclei, deep nuclear staining. The mitotic figures are more common, and the cells are arranged in a nest, streaked or rosette-like shape. 2 mixed type: with squamous cell carcinoma or adenocarcinoma, the disease is more male than female, male: female is 1.4:1, the age of onset is from 38 to 88 years old, the middle number is 62 years old, the symptoms are similar to squamous cell carcinoma, and the course of disease is shorter. X-ray showed medullary carcinoma, the predilection site was the middle and lower esophagus, and lymph node metastasis occurred in 2/3 cases. Similar to small cell lung cancer, esophageal small cell carcinoma has a high degree of malignancy, rapid progression, and early and extensive metastasis. Poor efficacy, treatment with surgery, radiotherapy and/or chemotherapy, long-term survival rate is still very low, the main cause of death is tumor metastasis to mediastinal lymph nodes, and blood transfer to the brain, liver, lung, bone and adrenal gland.
5. Esophageal malignant melanoma
Malignant melanoma originating in the esophagus is rare, accounting for 0.1% of the primary malignant tumor of the esophagus. It originates from the melanocytes in the esophagus. These cells are derived from the neuroectoderm, mostly located in the basal layer of the lower esophageal mucosa, generally polyps. Shape, nodular lobular mass, the color of the cut surface is grayish black or brown, although the volume is large, the covered squamous mucosa epithelium is mostly intact, occasionally with focal ulcer, tumor pedicle or wide base, tumor protruding tube Cavity, X-ray showed that the large intraluminal filling defect was similar to endoluminal esophageal cancer, single-shot, occasionally reported multiple, histological features: 1 cancer cells contain melanin particles confirmed by special staining. 2 Tumors are from connected squamous epithelium. 3 typical microscopically seen melanocytes with different degrees of activity between mucosa and submucosa, from normal appearance of melanocytes to highly atypical melanocytes resembling malignant sputum, the tumor spreads around, but rarely infiltrates Squamous epithelium or muscle layer, age of onset 7 to 80 years old, male to female ratio of 1.2:1 to 2:1, clinically mainly for dysphagia, but not typical progressive, sometimes slow development, and even repeated, esophageal melanin Although the tumor is sensitive to radiotherapy and the operation is easier to remove, most cases have a poor prognosis. Most of them die within 1 year after surgery. The average survival rate is 7.4 months. Individuals who survived preoperative radiotherapy plus surgery have survived for more than 3 years.
6. Esophageal primary malignant lymphoma
Divided into Hodgkin's disease and non-Hodgkin's lymphoma.
Primary Hodgkin's disease is extremely rare. Of the 354 extranodal cases in the literature, 5 (1.4%) occurred in the esophagus. The diagnosis of Hodgkin's disease in the esophagus must have the following three: 1 Learning is consistent with the characteristics of Hodgkin's disease; 2 lesions are confined to the esophagus, no lymph node involvement or only a few adjacent local lymph node involvement; 3 clinical or pathological evidence is sufficient to rule out Hodgkin's disease in the distance, according to which The primary esophageal Hodgkin's disease according to the Ann Arbor staging system should belong to the IE phase (only involving one external node) or IIE (limited to the single external site and its adjacent lymph node chain), X-ray and endoscopic lesions Often manifested as extra-mucosal filling defects, such as biopsy confirmed the disease, after comprehensive examination of other parts without this disease, IE patients should be given radiotherapy, esophageal non-Hodgkin's lymphoma in the English literature a total of 17 cases, NHL involving the gastrointestinal It is not uncommon to see the esophagus. The primary esophageal NHL belongs to the external position. In the 12357 group, the external body accounted for 12% (1497 cases), of which only 3 (0.02%) occurred in the esophagus. 2,526 cases (42 years) in a group of malignant esophageal tumors Period, NHL accounted for 0.1%, the main symptoms are dysphagia, some patients have swallowing pain, hematemesis and weight loss, patients with endoscopic diagnosis, visible extra-mucosal mass, 28% have ulcers, 28% in the upper segment, middle segment 39 %, the lower segment 33%, 22% of the esophageal lymph node involvement, treatment options: surgical resection, radiotherapy and chemotherapy, the overall median survival of 14 months, 5-year survival rate of 49%.
7. Esophageal malignant schwannoma schwannomas occur in the limbs, trunk and head and neck. It can be closely attached to the nerve trunk as seen by the naked eye. It is rare in the primary esophagus and less malignant. The schwannomas originate from the nerve. The benign tumor of the membrane cell sheath has fewer chances of malignant transformation. The cause is unknown. The esophagus has abundant nerve ending fibers, so this disease can also occur. Only the case of esophageal malignant schwannomas is reported in the literature. The age of onset is mostly in middle age. Above, the tumor grows along the nerve endings to form a tumor. According to the size of the tumor, the corresponding clinical symptoms appear. The clinical diagnosis is due to dysphagia. The treatment is mainly surgery, and it is difficult to diagnose before surgery. All cases are diagnosed by pathology.
8. Adenoid cystic carcinoma
The reported incidence of the disease accounted for 0.07% to 0.8% of all esophageal malignant epithelial tumors. It is believed that the tumor is derived from the submucosal vesicular gland. The microscopic findings are similar to those of the parotid adenoma, and the intertwined deep-stained epithelial cells are small. Cysts and glass-like cylinders, large tumors are cauliflower-like and infiltrating, occasionally ulcers, rarely polypoid, male: female is 2.5:1, age 36 to 83 years old, median 62 years old, about 50% of patients occur Transfer, and most of the liver, lung, brain and multiple organs involved, of which 3 cases were not treated, all died within 6 months; 2 cases of extensive metastases at the beginning of the treatment began chemotherapy for 1 month; treatment with surgery, chemotherapy and radiotherapy, survival 70% in 1 year, 35% in 3 years, and none in 54 cases.
9. Mucinous epidermoid carcinoma
McPeak and Arons reported the first case in 1947, and 21 cases appeared in the English literature, the incidence rate was 0.4% (11932 cases of comprehensive data), primary esophageal mucoepidermoid carcinoma (also known as adenoid or adenosquamous carcinoma) Histology is still controversial, most likely from the tubular vesicular mucous glands of the esophageal submucosa. Microscopically, there are varying amounts of mucus, squamous and intermediate cells in pieces or attached to the mucus-filled gap, roughly half Can be seen ulcers, the other half is indurated but the epithelium is intact, 82% has been soaked through the muscle layer to the fibrous membrane, a group of 22 cases reported in the literature, male: female is 5.6:1, aged 46-81 years old, middle 60 years, of which Radiotherapy or radiotherapy plus chemotherapy in 2 cases, all died within 7 months, 20 cases were resected, 4 cases died after surgery, 16 cases of 5 years survival rate of 18%, the deaths were all died of extensive conversion, the treatment was surgical resection The main treatment measures, the causes of postoperative death are local recurrence, lung, liver and brain metastasis, such as chemotherapy combined with radiotherapy and other comprehensive treatment to prevent recurrence.
10. Esophageal lymphosarcoma
Stephan 1890 reported the first case of primary esophageal lymphosarcoma, which was reported only at the same time. The incidence rate was lower than that in the gastrointestinal tract. The common mediastinal lymphosarcoma rarely metastasized to the esophagus. No nodular structure is divided into two types: nodular type and diffuse type. There is no difference in gender. The age of 30-70 years old, the most common symptoms are progressive dysphagia, sputum and post-sternal discomfort and weight loss during eating. Invasion of the lower esophagus is the most common, and often infringes on other parts, especially in the digestive tract. The stomach is more common, and it can also invade the liver and deep lymph nodes. The esophageal barium meal examination often shows a nodular filling defect, a narrow lumen, or a varicose vein change. X-ray signs of less ulcer formation, endoscopy and biopsy and immunohistochemical examination can further clarify the nature, treatment of patients with localized lesions and hemorrhagic obstruction, surgery can be supplemented with chemotherapy or radiotherapy to improve efficacy and prolong survival, preoperative Biopsy can confirm the diagnosis of radiotherapy or chemical treatment, and those who have survived for 9 years after treatment.
Examine
Examination of other malignant tumors of the esophagus
Upper gastrointestinal angiography.
Diagnosis
Diagnosis and differentiation of other malignant tumors of esophagus
Esophageal malignant tumors are rarely diagnosed before surgery, and most of them are pathologically diagnosed.
