Saudi Journal of Gastroenterology
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 14  |  Issue : 3  |  Page : 149-150
Small cell carcinoma of the esophagus


1 Department of Gastroenterology, Amrita Institute of Medical Sciences and Research Center, Amrita Lane, Elamakkara P.O., Cochin - 682 026, Kerala, India
2 Department of Pathology, Amrita Institute of Medical Sciences and Research Center, Amrita Lane, Elamakkara P.O., Cochin - 682 026, Kerala, India

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How to cite this article:
Chatni SS, Ravindran HK, Narayanan A, Balakrishnan V. Small cell carcinoma of the esophagus. Saudi J Gastroenterol 2008;14:149-50

How to cite this URL:
Chatni SS, Ravindran HK, Narayanan A, Balakrishnan V. Small cell carcinoma of the esophagus. Saudi J Gastroenterol [serial online] 2008 [cited 2019 Dec 14];14:149-50. Available from: http://www.saudijgastro.com/text.asp?2008/14/3/149/41738


Sir,

A 72-year-old man presented with progressive dysphagia and abdominal distension of two months' duration. An endoscopy was done, which revealed a circumferential, infiltrative tumor involving the mid-esophagus region. Multiple biopsies were taken from the esophagus, which showed a tumor composed of small, round or elongated, dark cells with hyperchromatic nuclei and scanty cytoplasm arranged in sheets, nests, ribbons, and in a peritheliomatous pattern. It was diagnosed as a primary small cell carcinoma (SCC) of the esophagus [Figure 1].

A Computed tomography scan of the abdomen, showed hepatomegaly with enhancing multiple focal lesions in both lobes of the liver. Fine needle aspiration cytology (FNAC) of these lesions showed heavy cellularity comprising of necrosis in the background with abundant sheets, clusters, and discrete populations of malignant cells. Individual cells were either round or spindle-shaped, with a high nuclear-cytoplasmic ratio and scanty-to-no cytoplasm. The nuclei were round or spindle-shaped with powdery nuclear chromatin.

Immunohistochemical studies showed patchy moderate positivity for cytokeratin [Figure 2], neuron-specific enolase and synaptophysin and patchy weak positivity for chromogranin. Due to the advanced nature of the disease, the patient was offered only symptomatic palliative treatment.

The incidence of esophageal SCC is reported to be 0.4-7.6% of all malignancies in different esophageal sites. [1] The cellular origins of esophageal SCC have been the subject of intense speculation and debate - it was initially thought to arise from the argyrophilic Kulchitsky cells in esophageal mucosal. [2] These cells have the ability to synthesize and store amines and to decarboxylate some amino acids - a feat that gave rise to the term, "amine precursor uptake, decarboxylation (APUD) cells." It would now appear that esophageal SCC is of endodermal origin derived from pluripotential basal epithelial cells, which serve as the common precursor for adenocarcinoma, squamous cell carcinoma, and SCC. [3] The small cells retain their potential for further differentiation into either mucin-producing or keratin-forming cells, which explains the coexistence of small cells, squamous, and glandular elements in the same lesion. Recent studies have shown that microsatellite instability (MSI) may be a more frequent cause in SCC than in squamous-cell carcinoma of the esophagus for the development of esophageal cancer. [4]

Grossly, esophageal SCC cannot be distinguished from esophageal squamous carcinoma. Esophageal SCC might present as an ulcerating, hard tumor mass on the mucosal surface of the esophagus or as a polypoid infiltrative process growing in the submucosal layer without any obvious ulceration of the mucosal surface. Microscopically, in all of the cases, the tumor is described as having a histological appearance of SCLC consisting of round to spindle-shaped cells with scanty cytoplasm, granular nuclei, inconspicuous nucleoli, along with ultrastructural and immunohistochemical evidence of neuroendocrine differentiation. [5]

Both esophageal SCCs and squamous cell carcinomas are similar with regard to the mean age of patients at the time of presentation, the location of the carcinomas and the presenting symptoms. However, esophageal SCC is a more aggressive tumor associated with rapid growth, and patients usually present with widespread metastasis. Prospective randomized trials of therapy for esophageal SCC are unlikely due to the rarity of the disease.


   Acknowledgement Top


We would like to acknowledge Dr. Fouzia Ziad, MD (Path) for performing the histopathologic and cytologic analysis.

 
   References Top

1.Takubo K, Nakamura K, Sawabe M, Arai T, Esaki Y, Miyashita M, et al . Primary undifferentiated small cell carcinoma of the esophagus. Hum Pathol 1999;30:216-21.  Back to cited text no. 1  [PUBMED]  
2.Craig SR, Carey FA, Walker WS, Cameron EW. Primary small cell cancer of the esophagus. J Thorac Cardiovasc Surg 1995;109:284-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Ugras S, Akpolat N, Yalcynkaya I, Karaayvaz M. Primary composite tumour with bipartite differentiation of the esophagus. Acta Chir Belg 2000;100:39-43.  Back to cited text no. 3    
4.Gonzalez LM, Sanz-Esponera J, Saez C, Alvarez T, Sierra E, Sanz-Ortega J. Case report: esophageal collision tumor (oat cell carcinoma and adenocarcinoma) in Barrett's esophagus: Immunohistochemical, electron microscopy and LOH analysis. Histol Histopathol 2003;18:1-5.  Back to cited text no. 4    
5.Noguchi T, Takeno S, Kato T, Wada S, Noguchi T, Uchida Y, et al. Small cell carcinoma of the esophagus: Clinicopathological and immunohistochemical analysis of six cases. Dis Esophagus 2003;16:252-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Sanjeev S Chatni
Department of Gastroenterology, Amrita Institute of Medical Sciences and Research Center, Amrita Lane, Elamakkara P.O., Cochin - 682 026, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.41738

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