CHONDROSARCOMA OF THE ESOPHAGUS [,

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as carcinosarcoma have con- tamed cell aggregates resembling chondro- sarcoma. [,, 4]. However, we wish to report the first instance of a primary esophageal.
Am

126:1175-1177,

JRoentgenol

1976

CHONDROSARCOMA

OF

IS5A

YAGHMAI’

AND

THE

ESOPHAGUS

G. Giaun’

GARY

ABSTRACT:

A 46-year-old man had a large noncalcified tumor in the wall of the thoracic esophanarrowing its lumen by projection of numerous firm nodular masses. The pathologic diagnosis was chondrosarcoma. Malignant degeneration of a tracheobronchial cartilaginous remnant is the main consideration in this first recorded case of esophageal chondrosarcoma. gus

Sarcomas account for 0.5%-I .o% of all malignant esophageal neoplasms [i]. In a series of 59 cases reviewed by Thorek and Neiman [2], there were 30 fibrosarcomas, eight leiomyosarcomas, five lymphosarcomas, five melanosarcomas, four rhabdomyosarcomas, and seven unclassified sarcomas. A few mixed tumors of the esophagus known as carcinosarcoma have contamed cell aggregates resembling chondrosarcoma

[,,

4].

However,

we

wish

to report

REPORT

revealed

numerous

firm

of Radiology,

Virginia

Commonwealth

were taken esophagus.

from different sites of the It was also noted that the

esophageal over the

mucosa exhibited firm submucosal

crunching

sound

the

biopsy

was

unusual mobility mass and that a

produced

forceps

and

by

insertion

separation

of

of

tumor

fragments. Microscopic evaluation of the opsies confirmed the presence of a differentiated chondrosarcoma (fig. 2). The intact elements mucosa

Other

contained

radiologic

bone

in

studies,

survey,

possible

failed

primary

sarcoma.

the

bi-

of

specimens

died

refused 8 months

extension

appeared

from

diffi-

the

intervention

and

complications Autopsy

a

as intratube or

However,

surgical

tumor.

as

chondro-

such Celestin

considered.

later

of the

lesion

ofthe

resection

any

a complete

any

procedure of a

were

patient

reveal

oforigin

radical

palliative insertion

gastrostomy

including

to

source

Since

cult, a esophageal

of local

permit

was

not

granted.

DISCUSSION

A unique is

poly-

feature

its

origin

devoid

of

matrix.

poid masses in the esophageal wall that were covered by grossly intact mucosa. The pathologic report on the biopsy was “chondrosarcoma, site undetermined.” Possibility of misDepartment

biopsies involved

of the specimen led to reOn this occasion three

indicated the intramural location of the tumor. Subsequently tomograms of the mediastinum and additional views with barium in the esophagus (fig. iC) demonstrated the extent of the tumor which did not have visible calcifications.

A 46-year-old Iranian farmer was referred to the University of Tehran-Tadj Pahlavi Cancer Hospital with a 6 month history of progressive dysphagia induced by solid food and a 4.5 kg weight loss. Chest roentgenograms showed widening of the mediastinum due to a large middle mediastinal tumor with ill-defined margins. An upper gastrointestinal series demonstrated marked irregularity of the wall of the distal two-thirds of the esophagus (figs. IA and iB). Numerous nodular masses projected into the narrowed and indistensible lumen. The peristaltic activity was absent so that the passage ofbarium distally was slow and dependent on the force of gravity. The diagnosis entertamed was sarcoma or carcinoma of the esophagus presenting as a varicoid tumor due to submucosal infiltration. Esophagoscopy

identification esophagoscopy.

esophageal

the first instance of a primary esophageal chondrosarcoma and review the pertinent literature to explain its path ogenesis. CASE

taken peat

of

the

ably

account

1175

College

that

that esophageal

normally

mesenchymal could

conceiv-

[,

6]. This the cell aggregates of are occasionally found carcinosarcomas [,

atypical for

of Virginia,

the wall

its

is

cartilage-forming of

esophageal for

chondrosarcoma

organ

necessary

explanation

chondrosarcoma within the

University-Medical

the

of this

an

Metaplasia

cells is an

in

Richmond,

site

Virginia

23298.

YAGHMAI

1176

AND

GHAHREMANI

FIG. x.-A and B, Views of esophagus with patient upright demonstrating extensive infiltration of wall resulting in irregular filling defects. C, Midline tomogram of chest with barium in esophagus showing large noncalcified tumor with mediastinal and intraluminal polypoid components.

4]. The in our ter

absence

ofany

patient

carcinomatous

appears

diagnosis.

tissue

to eliminate

However,

a real

the

oat-cell carcinoma, [6, 9]. This h\pothesis also

possibility

is

vide

malignant degeneration of a cartilaginous tracheobronchial remnant in the esophagus. Several recent reports indicate that defective separation of the embr’onic respira-

case other

tory

These

tract

behind

from clusters

the of

primitive

sor cells [7, 8]. These later form cartilaginous causing in

children

segmental and

foregut

tracheobronchial

stenosis adults

cells and

of the [6-9].

leaves precur-

sequestrated nodules This

may rings

esophagus congeni-

tal abnormality has also been implicated in the development of various unusual mors of the esophagus such as osteochon-

and cylindroma appears to pro-

droma,

lat-

an

The

lesion

roentgenographic

tumors and

irregular

narrowing I).

ment

A

[i,

are

The

esophagus

[1-3,

cifications

have

with usual

and 10].

not

sites lower

Grossly been

in 2,

10].

as an

extraluminal

middle

our

in-

resulting

esophageal

associated 10].

the

the

of

large

of

those described sarcoma [i, lesion

the

described.

present

pol\poid

is often

i)

for

herein

features to

commonly

filtrative (fig. (fig.

explanation

of the

are very similar types ofesophageal

sarcomas tu-

interesting

pathogenesis

in

lumen component esophageal of involvethird

of the

visible reported

calin

an

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