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Weekly Chest CasesArchive of Old Cases

Case No : 789 Date 2012-12-10

  • Courtesy of Dae Hee Han / Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
  • Age/Sex 60 / M
  • Chief Complaintdysphagia, weight loss
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Spindle cell carcinoma of the esophagus
Radiologic Findings
Axial unenhanced CT image, obtained at the time of presentation, shows the distal esophagus, which is expanded by a mass of soft-tissue attenuation. Axial contrast-enhanced CT shows intense enhancement of the mass. Coronal contrast-enhanced CT shows a huge sausage-shaped mass filling the midesophagus. Endoscopic image shows a large lobulated mass that occupies almost the entire middle esophagus. Photograph of the sectioned mass shows a yellow-tan internal structure. CT postop. 6 months shows a large recurrent pleural mass, which was confirmed with transthoracic needle biopsy.
Brief Review

Spindle cell carcinoma of the esophagus is rare (0.5~2.8 % of all esophageal neoplasm). The current understanding of this tumor is that it originates from an epithelial cell with divergent bidirectional differentiation.
Spindle cell carcinoma usually affects middle-aged men (male-to-female ratio, 4:1 to 9:1). Presenting symptoms are nonspecific; the most common are dysphagia and weight loss, followed by pain. Most spindle cell tumors (more than 90%) arise from the middle and distal esophagus. Most patients present early in the disease process, infrequently invading the esophageal wall, due to its intraluminal location and rapid growth (doubling time, 2.2~5 months). The tumor frequently spreads loco-regionally or metastasizes to the lung and liver (38~50%).
The surface of spindle cell carcinoma may be smooth, lobulated, or scalloped, and a cupola, or domelike shape, is usually seen at the proximal interface with the esophageal lumen. Focal ulcerations and luminal obstruction are infrequent.
At CT, spindle cell tumor is seen as an expansile, low-attenuation, intraluminal mass, with differentials including fibrovascular polyp, myofibroma, pedunculated lipoma, and leiomyoma (benign) and adenocarcinoma of the esophagus, leiomyosarcoma, fibrosarcoma, rhabdomyosarcoma, melanoma, oat cell carcinoma, and lymphoma (malignancies). The treatment and prognosis spindle cell tumor are not well defined due to its rarity. Esophageal resection with gastric pull-through is the most accepted treatment option. The 5-year survival rates of patients with spindle cell carcinoma (slightly more than 20%) are similar to those of patients with squamous cell carcinoma.
References
1. Sadej P, Feld RI, Toll AD, Palazzo JP. AIRP best cases in radiologic-pathologic correlation: spindle cell carcinoma of the esophagus. Radiographics. 2011 Nov-Dec;31(7):2035-9.
2. Takahashi T, Hokamura N. A case of esophageal spindle cell carcinoma. Jpn J Clin Oncol. 2011 Oct;41(10):1238-9.
Keywords
esophagus, malignant tumor,

No. of Applicants : 102

▶ Correct Answer : 3/102,  2.9%
  • - McGill university , Canada Badriya Al-Qassabi
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - SNUH , Korea (South) Euijin Hwang
▶ Semi-Correct Answer : 89/102,  87.3%
  • - mmcri , India sangeetha srinivasan
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - Goa Medical College , India Paresh Desai
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
  • - GM InHospital , Korea (South) Ju Won Lee
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
  • - GHOL, Hopital de Nyon , Switzerland Benoit Rizk
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - SCGH , Australia Yuranga Weerakkody
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - CHU Poitiers , France CHAN paul
  • - aarthi scans , India abirami mahadevan
  • - radiologist, aditya imaging centre , India vivek patel
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - CMC,Vellore , India Pushpinder Khera
  • - CHU de Poitiers , France St�phane Velasco
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - KMC,Manipal , India satish maddukuri
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Saint Malo , France jean-baptiste Noel
  • - University of British Columbia , Canada Amr Ajlan
  • - UWO , Canada S Lee
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - XiangYa hospital , China Xia Yu
  • - adıyaman , Turkey sukru sahin
  • - Hospital Universitario y Politecnico La Fe , Spain Carlos Munoz-Nunez
  • - China Medical University ,Ditamanson Medical Foundation Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun JunYeh
  • - Okayama University , Japan Satoko Kogawa
  • - GHICL , France manuel toledano
  • - Department of Radiology, Tseung Kwan O Hospital, Hospital Authority, Hong Kong Special Administrative Region, China , China Wai Pong CHU
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Chonnam university hospital , Korea (South) Jang mi Baek
  • - 전남대학교 병원 , Korea (South) Chan Park
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - 을지대학병원 , Korea (South) Jayoung Kim
  • - Cabinet de Pneumologie , Reunion Marc Di Francia
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Eunyoung Kim
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Joeun Kumgang hospital , Korea (South) ji eun seok
  • - Saga University , Japan Ryoko Egashira
  • - McGill University - Cairo University , Canada Hisham Mikhael
  • - GHTM ,STANLEY MEDICAL COLLEGE,CHENNAI , India siva raja
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - NZOZ Diagnostica s.c. Koszalin , Poland Krzysztof Owsianny
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Pneumology GHSR , Reunion fabrice paganin
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - SRMC , India prabhu radhan
  • - Montreal , Canada Drago Le King
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - H�pital du Sacr , Canada Andrea Ojanguren
  • - Fortis Hospital Mohali , India Rahat Brar
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - Myongji , Korea (South) soon-young Moon
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - All India Institute of medical sciences , India Justin Moses
  • - HIA Legouest - METZ , France Alban Gervaise
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Alswaida- zaid alsherity hospital , Syria jehad alakabani
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - CAC Rennes , France nicolas gautier
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - NTUH , Taiwan shihwen hu
  • - Yangsan Pusan National Hospital , Korea (South) JOOYEON JANG
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - royal melbourne hospital , Australia kimchi kings
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
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