Systemic treatments for resectable carcinoma of the esophagus

One of the most prevalent malignancies in the world is esophageal cancer(EC).The 5-year survival rate of EC remains pitiful despite treatment advancements.Neoadjuvant chemoradiotherapy in conjunction with esophagectomy is the standard of care for patients with resectable disease.The pathological complete response rate,however,is not acceptable.A distant metastasis or a locoregional recurrence will occur in about half of the patients.To increase the clinical effectiveness of therapy,it is consequently vital to investigate cutting-edge and potent therapeutic modalities.The approach to the management of resectable EC using immunotherapy has been considerably altered by immune checkpoint inhibitors.Systemic immunotherapy has recently been shown to have the potential to increase the survival of patients with resectable EC,according to growing clinical data.A combination of chemotherapy,radiation,and immunotherapy may have a synergistic antitumor impact because,according to mounting evidence,these treatments can stimulate the immune system via a number of different pathways.In light of this,it makes sense to consider the value of neoadjuvant immunotherapy for patients with surgically treatable EC.In this review,we clarify the rationale for neoadjuvant immunotherapy in resectable EC patients,recap the clinical outcomes of these approaches,go through the upcoming and ongoing investigations,and emphasize the difficulties and unmet research requirements.

Primary malignant melanoma of the esophagus:A case report

BACKGROUND Primary malignant melanoma of the esophagus(PMME)is a rare malignant disease whose clinical and molecular pathological features,origin and pathoge-nesis,diagnosis and treatment have not been elucidated.CASE SUMMARY In this paper,we report a case of a 73-year-old male with PMME.The patient complained of progressive dysphagia accompanied by substantial weight loss.Gastroscopy revealed a purple black bulging-type mass in the lower esophagus with easy bleeding on contact and scattered satellite lesions in the stomach.Histopathological biopsy revealed melanocytes in the esophageal mucosa.Physical examination and multidisciplinary consultation led to diagnostic exclusion of melanoma originating in other organs,such as the skin.Through this case report and literature review,we aimed to describe the clinical and molecular pathological features of PMME and summarize possible pathways of pathoge-nesis as well as cutting-edge therapeutic advances.CONCLUSION PMME is a rare malignancy of the esophagus with a poor prognosis.Clinicians should raise their awareness and be able to identify early lesions.

Primary malignant melanoma of the esophagus successfully treated with camrelizumab:A case report and literature review

An 83-year-old Chinese woman presented with a 3-month history of dysphagia.She also had a history of hypertension,type 2 diabetes,fundus hemorrhage,and cataract but no history of cutaneous,ocular,or other-site melanomas.Upper gastrointestinal tract angiography revealed gastritis and duodenal diverticulum;thus,an endoscopic review was recommended.Enhanced computed tomography of the chest and upper abdomen revealed the following:(1)Esophageal space-occupying lesions and mediastinal lymph node enlargement(considering the high possibility of esophageal cancer,further endoscopy was recommended)and(2)A small amount of right pleural effusion,with no significant lymph node infiltration or distant metastasis.Esophagoscopy identified a bulge mass blocking the esophagus from 23 to 30 cm from the incisors.The upper mass had a spherical clustering,while the lower mass significantly festered.Pathological biopsy samples were obtained from the esophagus 23 and 28 cm from the incisors.Tissue biopsy showed proliferation of large round tumor cells and melanocytes.Immunohistochemistry showed positive findings for HMB45 and MelanA;partially positive findings for S100,CK7,CK5/6,CAM5.2,LCA,P63,and TTF-1;and negative findings for Syn.The Ki-67 positivity index was approximately 60%.Based on these findings,the patient was diagnosed with malignant esophageal melanoma with enlarged mediastinal lymph nodes.She was then treated with five cycles of camrelizumab therapy combined with chemotherapy from October 18,2019,to May 5,2020.Gastroscopy review following two courses of combination therapy revealed that the esophagus was 23-25 cm away from the incisors,and there were two continuous uplifted and beaded masses that had a smooth and black surface,with each of them having a length and diameter of approximately 1 cm.Melanosis of the mucosa around the lumen was observed at 40 cm from the incisors to the cardia;the dentate margin was clear;and the cardia had no stenosis.The patient then received five courses of combination therapy and became consistently stable after partial remission.No severe adverse events related to the immunotherapy were recorded.Camrelizumab may be a viable treatment option for patients with PMME.Additional evidence from future clinical trials and research is necessary to fully validate our findings.

Clinicopathological characterization of ten patients with primary malignant melanoma of the esophagus and literature review

BACKGROUND Primary malignant melanoma of the esophagus(PMME) is a rare malignant disease and has not been well characterized in terms of clinicopathology and survival.AIM To investigate the clinical features and survival factors in Chinese patients with PMME.METHODS The clinicopathological findings of ten cases with PMME treated at Henan Provincial People’s Hospital were summarized. Moreover, the English-and Chinese-language literature that focused on Chinese patients with PMME from 1980 to September 2021 was reviewed and analyzed. Univariate and multivariate analyses were employed to investigate the clinicopathologic factors that might be associated with survival.RESULTS A total of 290 Chinese patients with PMME, including ten from our hospital and 280 from the literature were enrolled in the present study. Only about half of the patients(55.8%) were accurately diagnosed before surgery. Additionally, 91.1% of the patients received esophagectomy, and 88 patients(36.5%) received adjuvant therapy after surgery. The frequency of lymph node metastasis(LNM) was 51.2%(107/209), and LNM had a positive rate of 45.3% even when the tumor was confined to the submucosal layer. The risk of LNM increased significantly with the p T stage [P < 0.001, odds ratio(OR): 2.47, 95% confidence interval(CI): 1.72-3.56] and larger tumor size(P = 0.006, OR: 1.21, 95%CI: 1.05-1.38). The median overall survival(OS) was 11.0 mo(range: 1-204 mo). The multivariate Cox analysis showed both the p T stage [P = 0.005, hazard ratio(HR): 1.70, 95%CI: 1.17-2.47] and LNM(P = 0.009, HR: 1.78, 95%CI: 1.15-2.74) were independent prognostic factors for OS. The median disease-free survival(DFS) was 5.3 mo(range: 0.8-114.1 mo). The multivariate analysis indicated that only the advanced p T stage(P = 0.02, HR: 1.93, 95%CI: 1.09-3.42) was a significant independent indicator of poor RFS in patients with PMME.CONCLUSION The correct diagnosis of PMME before surgery is low, and physicians should pay more attention to avoid a misdiagnosis or missed diagnosis. Extended lymph node dissection should be emphasized in surgery for PMME even though the tumor is confined to the submucosal layer. Both the LNM and p T stage are independent prognosis factors for OS, and the p T stage is the prognosis factor for DFS in patients with PMME.

SUPERFICIAL CARCINOMAS OF THE ESOPHAGUS AND GASTRIC CARDIA A CLINICOPATHOLOGICAL ANALYSIS OF 141 CASES

From January 1970 to June 1999, 141 patients with superficial esophageal and cardiac carcinomas (SEC and SCC) underwent surgical treatment, Of the 141 patients 128 (90.8%) had slight symptoms related to swallowing, and the remaining 13 (9.2%) were asymptomatic, Balloon cytology and esophagoscopy proved very useful for the diagnosis of SEC and SCC, and Lugol's solution staining technique was an effective auxiliary diagnostic measure, Lymph node metastasis was not found in patients with epithelial (EP) cancer, However, it was present in one (2.9%) of 34 patients with muscularis mucosal (MM) invasion, and in 5 (8.6%) of 58 patients with submucosal (SM) cancer, The 5-year survival rates of the patients with SEC and SCC were 75.5% and 71.4%, respectively (P > 0.05). The different depth of tumor invasion including EP, MM and SM cancers showed significant differences in the 5-year survival rate (P < 0.05), Although the prognosis for the patients with lymph node metastasis is poor, we should advocate extended lymph node dissection in surgical treatment of the patients in whom MM and SM cancers are suspected.

Basaloid squamous carcinoma of the esophagus:clinicopathological,immunohistochemical and electron microscopic studies of 16 cases

Abstract Objective To further clarify the clinicopathological, immunohistochemical and electron microscopic features, and prognostic aspect of a rare esophageal carcinoma, i.e., basaloid squamous carcinoma (BSC). Methods The archival materials of 763 cases of esophageal malignancies (1977 1996) from the Dept. of Pathology, General Hospital of Nanjing Military Region, PLA, were reviewed and sixteen cases (2.1%) of BSC were detected. The clinical and pathological features of these cases were evaluated. Immunohistochemistry (S P method), histochemical staining, and electron microscope were utilized to further characterize the neoplasm. Results There were 9 males and 7 females, with a mean age of 58 years. The tumors were classified as stage Ⅰ (n=1), stage ⅡA (n=6), stage ⅡB (n=2), stage Ⅲ (n=5), and stage Ⅳ (n=2) according to the criteria of the UICC TNM classification system of malignant tumors (1987). Most neoplasms in our series were located in the middle third of the esophagus. Grossly, they had an appearance similar to that of conventional esophageal carcinoma. Histologically, they showed a typical cytoarchitectural pattern of BSC. The most important histologic feature of this tumor was that the carcinoma had a basaloid pattern, intimately associated with squamous cell carcinoma, dysplasia, or focal squamous differentiation. The basaloid cells were round or oval in shape with scant cytoplasm. The nuclei showed pleomorphism, hyperchromatin, and numerous mitotic figures. The basaloid cells were arranged mainly in the form of solid, smooth contoured lobules with peripheral palisading. Comedo necrosis in the islands of basaloid cells, small cystic spaces containing Alcian blue or PAS positive material, and PAS positive hyalinized stroma were frequently found. A panel of immunostains were used for the basaloid component of the tumor with the following results: cytokeratin (Pan),14/16 (+); epithelial membrane antigen, 16/16 (+); Vimentin, 4/16 (+); S 100 protein, 7/16 (+). Carcinoembryonic antigen and smooth muscle actin were negative. Electron microscopic (EM) study of 7 cases revealed that the basaloid cells are poorly differentiated, with a few desmosomes and fibrils and numerous free and polyribosome. The microcystic and intertrabecular spaces identified by light microscopy were seen under EM to be lined by basal membranes and filled with either loose reduplicated or compact globoid basal lamina showing fingerprint like pattern. Of the 11 cases with adequate follow up, 8 cases died within 2 years, the average survival time being 16.2 months. No cases of stages Ⅱ, Ⅲ, or Ⅳ survived beyond 5 years. The one year survival rate was 60% and two year 20%. Conclusion It is indicated that the BSC of the esophagus is a distinct clinicopathological entity with poor prognosis. The cellular differentiation and biologic behavior of the esophageal BSC were assumed to be situated between those of conventional squamous cell carcinoma and small cell carcinoma.

CARCINOMA ARISING IN BARRETT'S ESOPHAGUS (A REPORT OF 51 CASES)

Fifty-one patients with carcinoma arising in Barrett's esophagus were treated surgically from 1971 to 1990. This represented 10.2% of all treated cases with esophageal carcinoma during the same period. The mean age was 63 years. The most common symptom was dysphagia. According to PTNM staging, 18 were stage II,3 stage III and 3 stage IV. All patients were treated bysurgery. The 30-day hospital mortality was 3.98%. Theone, two and five-year survival rates were 45.9%, 25.0%and 13.6%, respectively. The 5-year survival rate wassignificantly greater for patrents with stage II (25.0%)than for parients with stage III + IV (4.s%) (P<0.05) andfor tumor length less than 6 cm (21%) than for tumorlength greater than 6 cm (0). The results indicate that thesurvival rate following resection is closely related to theclinical stage and tumor size.

Clinical Application of Modified Anyang Type 2 Esophageal Intubation Instrument──A New Esophageal Intubation Method

The preliminary experience in the clinical use of Anyang Type 2 esophageal intubation instrument, designed by ourselves, in 11 patients with severe esophageal obstruction due to advanced carcinoma of the esophageal was reported. The diagnosis of all 11 cases was confirmed by bariummeal roentgenography. After intubation, all the patients could take liquid or soft diet by mouth.There was no operative mortality and the patients survived 2 to 14 months (mean5.7 months). All of them could take food by mouth before death. The clinical application proved that the intubation has been a safe and suitable management.