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
CHONDROSARCOMA
e.
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ESOPHAGUS
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