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Japanese Journal of Clinical Oncology 31:517-521 (2001)
© 2001 Foundation for Promotion of Cancer Research

Leiomyosarcoma Arising in a Remnant Esophagus After Esophagectomy: a Case Report

Atsunori Nakao1, Yoshio Naomoto1, Kaori Shigemitsu1, Yasuhiro Shirakawa1, Tomoki Yamatsuji1, Masafumi Kataoka1, Minoru Haisa1, Munenori Takaoka1, Toshiyoshi Fujiwara1, Hiroshi Isozaki1, Nobuya Ohara2, Kenji Notohara2 and Noriaki Tanaka1,+

Departments of 1Surgery I and 2Pathology, Okayama University Medical School, Okayama, Japan

We report an extremely rare case of leiomyosarcoma arising from a remnant esophagus. A 52-year-old Japanese man was referred to our hospital for treatment of a tumor arising from the remnant esophagus. Four years earlier, he underwent a subtotal esophagectomy for esophageal squamous cell carcinoma (well differentiated squamous cell carcinoma, T1N0M0 Stage I) located in the lower esophagus. After preoperative studies, partial esophagectomy with laryngeal preservation and reconstruction using a free graft from the jejunum were performed. Histopathological and immunohistochemical examination revealed leiomyosarcoma without metastasis. Immunohistochemical examination showed that most tumor cells were positive for smooth muscle actin and vimentin, but were negative for cytokeratin and S100. The deeply biopsied specimens are helpful for preoperative histological diagnosis. Mitotic activity has been considered an important criterion of malignancy. However, some cases with minimal mitosis in the tumor grow rapidly and were associated with poor prognosis. Therefore, we advocate that the clinical behavior is the only true indication of malignancy. We also provide a review of 64 cases of esophageal leiomyosarcoma reported in the Japanese literature with available data between 1969 and 1999, including the present case, and discuss their clinicopathological features. Asynchronous occurrence of leiomyosarcoma and squamous cell carcinoma in the esophagus is most unusual and has never been reported. Patients with infiltrating type leiomyosarcoma measuring more than 5 cm in diameter tend to have a poor prognosis. Chemotherapy did not exhibit any survival benefits. In the present patient, no recurrence has been noted for 23 months after surgery.

+ For reprints and all correspondence: Yoshio Naomoto, First Department of Surgery, Okayama University Medical School, 2–5–1 Shikata-cho, Okayama 700-8558, Japan


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