C.S. Pramesh

Small cell carcinoma of the esophagus: the Tata Memorial Hospital experience

BACKGROUND Small cell carcinoma of the esophagus is a rare disease, characterized by aggressive progression. It has a high incidence of metastatic disease at presentation and a poor overall prognosis. Treatment protocols are not well established because of the paucity of cases and a lack of large studies. METHODS We performed a retrospective review of all patients with small cell carcinoma of the esophagus diagnosed at the Tata Memorial Hospital between 1985 and 2001. We retrieved and analyzed data regarding demographic details, diagnosis, staging, type of treatment, and overall survival. RESULTS Eighteen patients with a mean age of 62 years (range 48 to 80 years) diagnosed as having small cell carcinoma of the esophagus were analyzed. The group included 13 men and 5 women. Seven of the 18 patients (39%) presented with metastatic disease including 5 patients (28%) with liver metastases. Four patients were treated with surgery, with or without chemotherapy or radiotherapy. Three patients were treated with combination chemoradiotherapy, 2 patients with chemotherapy alone, and 5 patients with radiotherapy alone. Four patients with advanced disease and poor general condition were not offered any treatment. The overall median survival of our patients was 6 months. Patients treated with surgery and chemotherapy had a better overall survival. CONCLUSIONS Small cell carcinoma of the esophagus should be regarded as a systemic disease with a high distant failure rate. Treatment strategies hence must incorporate systemic chemotherapy along with radical surgery or radiotherapy as part of a multimodality approach.

Primary endobronchial synovial sarcoma confirmed by SYT-SSX1 fusion gene transcript by reverse transcriptase polymerase chain reaction

Primary sarcomas of lung are rare compared to metastatic sarcomas. Herein, we report a rare case of primary pulmonary synovial sarcoma with polypoid endobronchial growth in a 35-year-old lady who presented with cough and dyspnea. A malignant pulmonary tumor was suspected and left pneumonectomy was performed. Grossly, a non-encapsulated polypoidal endobronchial tumor measuring 6 cm in greatest diameter, with a solid, tan-white cut surface was identified. Microscopically, tumor was characterized by a proliferation of oval to spindle-shaped cells arranged in sheets and fascicles. Focal hemangiopericytomatous pattern was noted. Immunohistochemically, tumor cells were positive for vimentin, BCL-2, MIC-2 and calponin and focally positive for pancytokeratin and epithelial membrane antigen. A subsequent molecular analysis performed using reverse transcriptase-polymerase chain reaction with RNA extracted from paraffin-embedded tissue, revealed SYT/SSX1 fusion gene which confirmed the diagnosis of synovial sarcoma. The utility of immunohistochemistry and molecular techniques in diagnosis of such a rare case is stressed and the relevant literature is discussed.

Enteral feeding access with feeding jejunostomy is advisable after esophagectomy.

We thank Dr Metin and associates for their interest in our paper and for sharing their experience of massive hemoptysis. They recommended a prompt surgical treatment whatever the patient and whatever the origin of bleeding. We want to congratulate them for their good result (11.5% mortality rate). However, Dr Metin et al. did not specify the cause of bleeding and one may easily suppose that it is a typical surgical recruitment. We do not believe that prompt surgery is always possible in poor functional status of the patient. We think that it is not advisable to perform prompt pulmonary resection for massive hemoptysis occurring in cystic fibrosis patients, as in last course of radiotherapy for unresectable lung cancer, or in case of bilateral bronchiectasis? These cases above mentioned are types of patient usually referred to us. As we wrote management is performed by a multidisciplinary approach. We have highlighted [1] the circumstances in which prompt surgical treatment may be required (bleeding coming from great pulmonary vessels). One may suppose that at least three patients in Dr Metin’s series might be treated by percutaneous embolization (those treated by segmentectomy). In other words, it seems difficult to treat all patients by prompt surgery in massive hemoptysis.

Is compromising on surgical margins in tracheal resection for cancer justified

the surrounding lung due to the pulmonary contusion is an image not visible in TB cases [2,4]. The traumatic lesions are always in the middle and lower lobes or adjacent to the area of the pulmonary contusion [4,5] and they usually are lobulated [4], whereas other lesions including TB cavities would not necessarily be so positioned and are usually found apically. Additionally, in cases with TB, mediastinal lymphadenopathy is always present with apparent calcified lymph nodes and granulomatous tissue [2]. 5. Follow-up: the size, shape and nature of the wall of a traumatic cyst changes in a relatively short period unlike other kinds of cystic or cavitary lesions [4].