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Case Reports
. 2024 Nov 26:14:1497154.
doi: 10.3389/fonc.2024.1497154. eCollection 2024.

A unique tripartite collision tumor of the esophagus: a case report and literature review

Shuai Luo  1 , Xiaoxue Tian  1 , Ting Xu  1 , Jinjing Wang  1
Affiliations
Case Reports

A unique tripartite collision tumor of the esophagus: a case report and literature review

Shuai Luo et al. Front Oncol. .

Abstract

Background: The coexistence of two or more distinct neoplasms within the same anatomical site characterizes collision tumors. While the presence of dual tumors is frequently observed in esophageal cases, the simultaneous occurrence of three distinct tumor types is extremely rare, posing significant challenges for pathological evaluation and diagnosis. Surgical resection remains the primary treatment, with generally favorable outcomes.

Case presentation: A 58-year-old male with a two-month history of progressively worsening dysphagia over the past 10 days underwent a gastrointestinal barium meal examination, which revealed an irregular filling defect measuring approximately 89×50 mm in the mid-thoracic esophagus. Subsequent gastroscopic biopsy confirmed undifferentiated pleomorphic sarcoma in the mid-esophageal tissue. As the dysphagia advanced, a partial esophagectomy with lymph node dissection was performed. Postoperative pathology revealed a composite tumor consisting of adenoid cystic carcinoma, undifferentiated pleomorphic sarcoma, and focal squamous cell carcinoma. Squamous cell carcinoma metastasis was identified in one lymph node. No adjuvant therapies, such as chemotherapy, radiotherapy, targeted therapy, or immunotherapy, were administered following surgery. The patient had been under monitoring for 101 months, with no signs of recurrence or metastasis.

Conclusion: This case represents the first documented instance of a tripartite collision tumor in the esophagus, composed of undifferentiated pleomorphic sarcoma, squamous cell carcinoma, and adenoid cystic carcinoma, with clear histological distinction. A thorough review of the literature was performed to summarize clinicopathological features. Surgical resection leads to a favorable prognosis. Tumors containing both carcinomatous and sarcomatous elements tend to have a more favorable prognosis compared to those composed entirely of carcinomatous tissue, providing valuable insights for future diagnostic and therapeutic strategies.

Keywords: adenoid cystic carcinoma; carcinoma; collision tumor; diagnosis; esophagus; sarcoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Gastroscopy identified a mass extending 28-32 cm from the incisor, occupying two-thirds of the esophageal lumen.
Figure 2
Figure 2
Histopathologic assay of the biopsy revealed a proliferation of oval or spindle cells. H&E ×220.
Figure 3
Figure 3
Microscopic analysis identified well-defined boundaries between the three tumor types: undifferentiated pleomorphic sarcoma (40%, Yellow arrow), squamous cell carcinoma (5%, Black arrow), and adenoid cystic carcinoma (55%, Red arrow). H&E ×5.
Figure 4
Figure 4
In Area 1, components of undifferentiated pleomorphic sarcoma. H&E ×200.
Figure 5
Figure 5
In Area 2, components of squamous cell carcinoma. H&E ×200.
Figure 6
Figure 6
In Area 3, components of adenoid cystic carcinoma. H&E ×70.
Figure 7
Figure 7
Immunohistochemical analysis of the undifferentiated pleomorphic sarcoma component revealed positivity for Vimentin. EnVision ×200.
Figure 8
Figure 8
Immunohistochemical analysis of the squamous cell carcinoma component showed positivity for CK. EnVision ×100.
Figure 9
Figure 9
Metastasis of squamous cell carcinoma in one lymph node. H&E ×7.
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