食管癌肉瘤的临床病理特征及影像学分析

Clinicopathological Characteristics and Imagings Findings of Esophageal Carcinosarcoma

目的探讨食管癌肉瘤的临床病理特征及影像学表现。方法回顾分析经病理证实的6例食管癌肉瘤患者的临床、病理及影像资料,结合文献复习影像征象,并与临床病理进行对照分析。结果 6例中男4例,女2例,年龄35~70岁。1例位于食管上段,1例位于食管中上段,4例位于食管中下段。长度4. 0~11. 2 cm,平均8. 6cm。内镜检查示肿块均突入腔内,4例呈灰红色息肉样,2例呈溃疡性肿块。MSCT均表现为管壁偏心性不对称增厚,平扫均呈软组织密度,增强扫描明显不均匀强化,均无周围侵犯,1例纵隔淋巴结肿大。另1例行18F-FDG PET/CT检查表现为异常放射性浓聚,最大标准摄取值(SUVmax)为15. 8。病理特征为癌肉瘤组织由癌成分与肉瘤样成分相互掺杂,均以肉瘤样细胞占优势,合并少许鳞状细胞癌成分。结论食管癌肉瘤的影像学表现与肉瘤及癌性成分有关,具有一定特征性,确诊需依靠病理及免疫组织化学检查。

Objective To explore the characteristics of pathological features and imaging findings of esophageal carcinosarcoma.Methods Six patients with esophageal carcinosarcoma were pathological confirmed.The clinical,pathological findings,and the imaging materials were analyzed retrospectively.Combined with the literature review,the imaging features were discussed and correlated with pathological results.Results Among the 6 cases with esophageal carcinosarcoma,there were 4 males and 2 females,aged 35 to 70 years.1 case was located in the upper segment,1 case located in the middle-upper and 3 were located in the middle-lower segment of the esophagus.The length of the lesion was 4.0 to 11.2 cm,average 8.6 cm.Endoscopic examination showed that protuberant tumor grew in the esophageal lumen.4 cases presented with grayish red polyps,and 2 had ulcerative mass observed under endoscopy.MSCT showed esophageal wall had eccentric thickening,with irregular shaped lumps,appeared as a soft tissue density,with heterogeneous enhancement after administration of contrast medium,and the adjacent tissue was none invaded.1 case has enlarged lymph nodes in mediastinum.One patient was examined by positron emission tomography and computed tomography.The imaging demonstrates increased radiotracer uptake with a maximum standard uptake value(SUVmax)of 15.8 on 18F-FDG PET/CT.Histologically,both carcinomatous and sarcomatous components were seen.The sarcoma element formed the bulk of the lesion and there was combined a few squamous cell carcinomas.Conclusion The imaging features of the esophageal carcinosarcoma depend on the subtypes of the carcinoma and sarcoma elements,and have certain characteristic manifestations.The definitive diagnosis relies on histopathological and immunohistochemical examinations.