Primary small cell carcinoma of the esophagus: clinicopathological and immunohistochemical features of 21 cases

Abstract

Background: Primary small cell carcinoma (SCC) of the esophagus is a rare and aggressive tumor with poor prognosis. In this study, we report the clinicopathological characteristics of 21 cases of small cell carcinoma of the esophagus treated at the Cancer Center of Sun Yat-Sen University, with particular focus on the histologic and immunohistochemical findings.

Methods: Twenty-one patient records were reviewed including presenting symptoms, demographics, disease stage, treatment, and follow-up. Histologic features were observed and immunohistochemical detection of cytokeratin (CK), epithelial membrane antigen (EMA), neuron specific enolase (NSE), synaptophysin (Syn), chromogranin A (CgA), neuronal cell adhesion molecules (CD56), thyroid transcriptional factor-1 (TTF-1) and S100 protein (S100) was performed.

Results: The median age of patients in the study was 56 years, with a male-to-female ratio of 3.2:1. Histologically, there were 19 "homogenous" SCC esophageal samples and 2 samples comprised of SCC and well-differentiated squamous cell carcinoma. The percentages of SCC samples with positive immunoreactivity were Syn 95.2%, CD56 76.2%, TTF-1 71.4%, NSE 61.9%, CgA 61.9%, CK 57.1%, EMA 61.9%, and S100 19.0%, respectively. The median patient survival time was 18.3 months after diagnosis. The 2-year survival rate was 28.6%.

Conclusion: Our study suggests that esophageal SCC has similar histology to SCC that arises in the lung compartment, and Chinese patients have a poor prognosis. Higher proportion of positive labeling of Syn, CD56, CgA, NSE, and TTF-1 in esophageal SCC implicate that they are valuably applied in differential diagnosis of the malignancy.

Figure 1

Hematoxylin and eosin-stained sections showing morphology of esophageal SCC morphology. Nested or organoid growth pattern was the most common (A). Sheet-like growth was a dominant pattern in 3 cases (B). In one case, we observed marked cellularity similar to lymphoma (C). Combined SCC of the esophagus with well-differentiated squamous cell carcinoma (D). (Mag. × 400).

Figure 2

Immunohistochemical staining for CD56, Syn, CK, and EMA in the combined SCC case. CD56 (A) and Syn (B) immunopositivity was observed in the SCC area, and CK (C) and EMA (D) immunopositivity was observed in the regions of squamous cell carcinoma (Mag. × 400).