Simultaneous Resection of Esophageal Carcinosarcoma with Cancer of the Stomach and Transverse Colon: A Case Report.

Introduction: Esophageal carcinosarcoma is a rare malignant neoplasm composed of both carcinoma and sarcoma components. Here, we report a case of esophageal carcinosarcoma in a patient with cancers of the transverse colon and stomach who underwent simultaneous resection of all 3 malignancies.

Case Presentation: A 71-year-old man presented with dysphagia and was diagnosed with carcinoma in the mid-thoracic esophagus. Laboratory data showed normal tumor markers-carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and carbohydrate antigen 19-9 (CA19-9). Esophagoscopy confirmed the presence of a polypoid tumor in the middle thoracic esophagus. Endoscopic biopsy specimens were reported as spindle cell carcinoma. Colonoscopy revealed a semicircular tumor in the transverse colon. Simultaneous esophagectomy and regional lymphadenectomy and transverse colon resection using video-assisted thoracoscopic surgery (VATS) and hand-assisted laparoscopic surgery (HALS) were planned. Intraoperative findings revealed advanced cancer in the upper part of the stomach, which was also resected. Macroscopically, there was an 11-cm type 1 tumor in the middle thoracic esophagus and a 3.5-cm type 3 tumor in the gastric cardia. Microscopically, the esophageal tumor was composed of well-differentiated squamous cell carcinoma and spindle-shaped cells resembling leiomyosarcoma and was diagnosed as carcinosarcoma. Spindle-shaped sarcomatous cells were positive for vimentin and α-smooth muscle actin (αSMA) by immunohistochemistry. Most of the tumor showed highly atypical sarcomatous component that reached deep into the submucosa, and regional lymph node metastases were observed. Gastric cancer was a moderately differentiated tubular adenocarcinoma that penetrated the serosa and reached the peritoneal cavity. The transverse colon tumor was a well-differentiated adenocarcinoma invading the muscularis mucosa.

Conclusions: We report a rare case of triple cancer, including esophageal carcinosarcoma. Simultaneous resection of esophageal carcinosarcoma with multiple cancers should be carefully considered based on the patient's condition and reconstruction method.