Verrucous carcinoma of the esophagus: improvement of diagnosis and prognosis
Satoshi Tabuchi1, Kazuo Koyanagi2*, Soji Ozawa2, Shigeyuki Kawachi1
1Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center
2Department of Gastroenterological Surgery, Tokai University School of Medicine
Verrucous carcinoma of the esophagus (VCE) is a special variant form of esophageal squamous cell carcinoma. VCE presents a unique superficial growth pattern that is characterized as an exophytic, slow-growing mass. We reviewed previous reports of the 56 cases and divided them into two groups: from 1967 to 1999 (19 cases; the former period) and from 2000 to 2020 (37 cases; the latter period) to compare the diagnosis and prognosis of VCE. Patients with T4 disease tended to be higher in 6 (32%) of the19 cases in the former period. On the other hand, T1 and T2 diseases were high in 23 (62%) and T4 was very low; only 2 (5%) of the 37 cases in the latter period. It is presumed that surveillance by endoscopic examination has become common, as the risk factors and characteristic appearances of VCE are well known. Moreover, improvements in surgical procedures and perioperative management in recent years has been related to the favorable prognoses in the latter period. Since reports in the literature have stated that chemotherapy and radiotherapy might be inadequate as means of curative therapy, esophagectomy should be recommended as curative treatment because of VCE’s low potential for lymph node and distant organ metastasis.
View / Download Pdf Malignant Retroperitoneal Tumor of the Peripheral Nerve Sheath Associated with Neurofibromatosis Type 1
Beatriz Cros Montalban*, Pilar Palacios Gasos, Rocio Ferrer Sotelo, Jose Fernado Trebolle, Monica Valero Sabater, Carlos Yanez Benitez, Elena Gonzalvo Gonzalez, Juan Luis Blas Laina
Hospital Royo Villanova, Zaragoza, Spain
The malignant peripheral nerve sheath tumor (MPNST) is a spindle cell sarcoma, which accounts for 5-10% of soft tissue sarcomas. We present the case of a 39-year-old woman with a history of Neurofibromatosis type 1, who in the study for abdominal pain was diagnosed on abdominopelvic CT with a large retroperitoneal adenopathic conglomerate without distant extension. By laparoscopy, complete exeresis of the lesion was performed, with nil complications in the postoperative period. In the histological sections, a nodular lesion of 4 cm in diameter was identified, with neoplastic proliferation showing diverse growth patterns, low mitotic index and positive immunohistochemistry for S-100 and Vimentin, confirming the diagnosis. MPNSTs are aggressive behavioral sarcomas with a high recurrence rate. They present distant metastases, even in early clinical stages. The treatment of choice is complete resection with free margins, because of the high rate of recurrence and limited therapeutic response to radiotherapy and chemotherapy.
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