食管碰撞癌9例临床病理分析

Clinicopathologic features of esophageal collision carcinoma:analysis of nine cases

目的探讨食管碰撞癌的临床病理学特征、诊断及鉴别诊断。方法回顾性分析9例食管碰撞癌的临床病理学及免疫表型特征,并复习相关文献。结果9例碰撞癌中,7例男性,2例女性,年龄54~74岁,平均64岁。肿瘤好发部位为食管中下段,为单个肿块,最大径0.5~4.0 cm,平均约2.3 cm。形态学上,鳞状细胞癌碰撞小细胞癌6例,鳞状细胞癌碰撞腺样囊性癌1例,大细胞神经内分泌癌碰撞腺样囊性癌1例,大细胞神经内分泌癌碰撞横纹肌肉瘤1例,可识别的两种成分无移行及过渡,间隔以纤维结缔组织。7例获得随访,随访时间0.5~6年,其中4例存活,3例死亡。结论食管碰撞癌缺乏特异性临床表现,术前诊断困难,术后病理检查是唯一的确诊方法。在实际工作中,应注意充分取材,避免漏诊。

Purpose To summarize the clinicopathologic features,diagnostic key points of esophageal collision carcinoma.Methods The clinical data and pathological features of 9 cases of esophageal collision carcinoma were analyzed retrospectively,and the related literatures were reviewed.Results There were 9 cases of collision cancer in this study,including 7 males and 2 females,aged from 54 to 74 years,mean 64 years.The most common site of tumor was the middle and lower part of the esophagus.The tumor was a single mass with a maximum diameter of 0.5-4.0 cm,mean 2.3 cm.Morphologically,squamous cell carcinoma collided with small cell carcinoma in 6 cases,squamous cell carcinoma with adenoid cystic carcinoma in 1 case,large cell neuroendocrine carcinoma with adenoid cystic carcinoma in 1 case,and large cell neuroendocrine carcinoma with rhabdomyosarcoma in 1 case.The two identifiable components had no transition and were separated by fibrous connective tissue.Follow-up data were obtained in 7 cases with a follow-up period of 0.5-6 years,4 cases survived and 3 cases died.Conclusions Esophageal collision carcinoma is very rare.Due to the lack of specific clinical manifestations,preoperative diagnosis is difficult,and postoperative pathological diagnosis is the only way to make a definite diagnosis.In practical work,we should pay attention to the full selection of sample to avoid missed diagnosis,and accurate diagnosis is helpful for clinicians to deal with patients properly.