食管碰撞癌5例临床病理学特征

Clinicopathologic features of esophageal collision carcinoma: Analysis of five cases

目的:探讨食管碰撞癌的临床病理学特征、病理诊断、免疫表型及鉴别诊断.方法:收集漯河市中心医院及漯河市第五人民医院2008-01/2015-12经常规HE及免疫组织化学染色确诊的食管碰撞癌5例,同期食管癌1412例的临床和病理学资料,结合文献,进行回顾性分析.结果:食管碰撞癌是一种罕见的肿瘤组合类型,高发年龄>65岁,男性高发;好发部位为食管中段、食管与贲门交界处;病理组织学特点以鳞状细胞癌碰撞腺癌、鳞状细胞癌碰撞小细胞神经内分泌癌、鳞状细胞癌碰撞平滑肌肉瘤为特点,两种碰撞肿瘤位置靠近,中间隔以非肿瘤性间质,无移行及过渡,有各自的转移途径.食管碰撞癌以鳞癌和腺癌的碰撞常见.结论:食管碰撞癌非常罕见,与一般食管癌相比,缺乏明显的特异性临床表现,术前诊断比较困难,术后病理诊断是唯一的确诊方法,因此在碰撞癌的诊断中,应充分取材,避免漏诊,以更好的指导临床的放化疗方案.

AIM： To summarize the clinicopathologic features, pathological diagnosis, immunophenotype and differential diagnosis of esophageal collision carcinoma.METHODS： The clinical and pathological data for five patients with pathologically confirmed esophageal collision carcinoma and 1412 patients with esophageal carcinoma were studied retrospectively against the background of the literature. The data of those patients were collected from the Central Hospital of Luohe and the Fifth People＇s Hospital of Luohe between January 2008 and December 2015.RESULTS： Esophageal collision carcinoma is a rare combination of tumor types, more common in males than in females. The peak onset age is more than 65 years. It is found frequently in the middle and lower segments of the esophagus and the esophagogastric junction. Squamous cell carcinoma collided with adenocarcinoma, squamous cell carcinoma collided with small cell carcinoma and squamous cell carcinoma collided with leiomyosarcoma are the histopathological characteristics of those five cases. Esophageal collision carcinoma represents a coexistence of two adjacent but histologically different malignant neoplasms without histological admixture in an organ. Squamous cell carcinoma collided with adenocarcinoma is the most common type of esophageal collision carcinoma.CONCLUSION： Esophageal collisioncarcinoma is a rare combination of tumor types, without special clinical features, and it is difficult to diagnose before operation. Pathological findings are the only way to make a correct diagnosis after operation. Therefore, fully sampling the tissues should be performed to guide reasonable radiotherapy or chemoradiotherapy and avoid missed diagnosis.