Diagnostic and therapeutic analysis of three cases of sarcomatoid carcinoma of the esophagus

Abstract Objective: This study aimed to investigate the clinicopathological features, imaging manifestations, and treatment strategies for esophageal sarcomatoid carcinoma. Results: All three cases involved male patients with ages ranging from 68 to 74 years, with an average age of 71.0 years. The duration of the disease varied from 20 to 60 days, with an average of 36.7 days. Tumors in all three cases were located in the middle and lower esophagus. CT scans revealed irregular mass shadows and thickened esophageal walls, which exhibited significant enhancement upon enhanced scanning. Barium meal examinations of the upper digestive tract showed two cases of intraluminal type, characterized by localized filling defects in the esophageal lumen with smooth edges and no obvious expansion above the lesion, while one case exhibited a thickening type with a rough and rigid wall, mucosal destruction, interruption, and narrowed lumen. Two cases underwent surgical treatment, with OVER-LAP anastomosis of the esophageal and gastric aortic arch under thoracoscopy. One case received docetaxel chemotherapy. After a 1.5-year follow-up, no tumor recurrence or metastasis was observed.Pathological findings revealed one case of squamous cell carcinoma with an adjacent rough area also exhibiting squamous cell carcinoma in situ, while the other case was diagnosed as adenocarcinoma. Immunohistochemistry showed positivity for epithelial cancer components (CK, EMA, Desmin) and sarcomatoid components (Vimentin, EMA, SMA). Conclusion: Esophageal sarcomatoid carcinoma is a rare malignant tumor demonstrating bidirectional differentiation of cancer and sarcoma components. Although its early prognosis appears to be more favorable compared to typical esophageal squamous cell carcinoma, long-term prognosis remains uncertain. Surgical intervention constitutes the primary treatment modality, while radiotherapy and chemotherapy may contribute to prolonging patient survival.