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  Table of Contents  
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 603-604

Squamous cell and neuroendocrine carcinoma of esophagus: Collision versus composite tumor: A case report and review of literature

1 Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
2 Department of Medical Pathology, Ankara Numune Education and Research Hospital, Ankara, Turkey

Date of Web Publication10-Mar-2016

Correspondence Address:
Ozan Yazici
Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.178436

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How to cite this article:
Yazici O, Aksoy S, Ízhamam EU, Zengin N. Squamous cell and neuroendocrine carcinoma of esophagus: Collision versus composite tumor: A case report and review of literature. Indian J Cancer 2015;52:603-4

How to cite this URL:
Yazici O, Aksoy S, Ízhamam EU, Zengin N. Squamous cell and neuroendocrine carcinoma of esophagus: Collision versus composite tumor: A case report and review of literature. Indian J Cancer [serial online] 2015 [cited 2021 Jan 18];52:603-4. Available from:


Esophagus tumors rarely show two different histology. Neuroendocrine component of these tumors are the most important determinant of mortality. Therefore, pathological discrimination of neuroendocrine component is critical for these patients. Mixed tumors of esophagus can be classified as composite and collision. We report a case of composite tumors of esophagus. A 65-year-old female was admitted to hospital with complaint of dysphagia. Esophagogastroduodenoscopy reveal that locally advanced mass, which was at 32nd cm of esophagus. Combination of squamous cell carcinoma, in situ squamous cells and high-grade neuroendocrine carcinoma were observed in histopathological examination of biopsy specimen. We performed two cycles of neoadjuvant cisplatin and etoposide regimen. Subsequently, subtotal esophagectomy with lymphadenectomy was performed. Unfortunately, the patient died post-operatively due to sudden respiratory failure on the 5th day of the operation. Pathological examination of surgical specimen revealed in situ and invasive squamous cell carcinoma and neuroendocrine carcinoma with transition zone [Figure 1]. Immunostaining of tumor revealed squamous component had strong and extensive staining with p63 [Figure 2] and keratin. Additionally, neuroendocrine component had positive staining with synaptophysin, Cluster of differentiation (CD) 56 and chromogranin [Figure 3]. The neuroendocrine component showed high-grade, which was clinically equal to small cell carcinoma of the lung. Primary composite tumor of the esophagus is rare and only six cases have been reported in the literature up to November 2012 [Table 1]. Composite and collision of tumors are two different entities which are difficult to distinguish from each other. A collision of tumor consists of two independent neoplasms growing in close proximity until they have noticed as one lesion. This is rare situation with unknown mechanism. Collision of tumors believed to result from coincidental neoplastic change or dedifferentiation by local carcinogenic stimulus or paracrine effect released by one of tumor. As a result of these effects; two different cancer stem cells leads two different cancer cell lineages.[1] In composite tumors; one neoplastic clone diverges in to two different cell lineages.[2] Histologically composite tumors emerge from a single pluripotent precursor stem cell give rise to 2 lines of differentiation, which can be explained by multidirectional potential of cancer stem cell.[3] In our case, histological examination showed transition areas which was interface between squamous and neuroendocrin component of tumor with indistinctive borders. Thus, we diagnosed as composite tumors [Figure 1]. Due to the concomitant presentation of three different histological features with two invasive and one in situ component, our present case differs from other cases in the literature [Table 1]. Until now in the literature, there has been one case of collision of squamous and neuroendocrine carcinoma of esophagus.[4] Esophageal composite tumors are uncommon malignancies of esophagus. It is important to distinguish esophageal collision from esophageal composite tumor. In the presented case, tumor showed multidirectional differentiation, including in situ and invasive squamous neoplasia and neuroendocrine tumor cells. Therefore, the tumor in the presented case thought to be originated from one totipotential, multidirectional cancer stem cell. To our knowledge, this is the first case of composite tumors of esophagus with in situ and invasive squamous cell carcinoma with concomitant neuroendocrine components[10].
Figure 1: Resection material of esophagus, low magnification image showing squamous “in situ” component (arrow heads) and neuroendocrne component (stars) and squamous invasive carcinoma (arrow)

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Figure 2: Immunostaining with p63 showing squamous component (arrows)

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Figure 3: Immunostaining with chromogranin showing neuroendocrine component (arrows)

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Table 1: Clinicopathological charectersitics of the mixed tumors of esophagus[5],[6],[7],[8],[9],[10]

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 ╗ References Top

Fenoglio-Preiser CM. Carcinomas and other epithelial and neuroendocrine tumors of the large intestine. In: Fenoglio-Preiser CM, editor. Gastrointestinal Pathology. An Atlas and Text. 2nd ed. Philadelphia: Lippincott-Raven; 1999. p. 909-10  Back to cited text no. 1
Lyda MH, Fenoglio-Preiser CM. Adenoma-carcinoid tumors of the colon. Arch Pathol Lab Med 1998;122:262-5.  Back to cited text no. 2
Lewin K. Carcinoid tumors and the mixed (composite) glandular-endocrine cell carcinomas. Am J Surg Pathol 1987;11:71-86.  Back to cited text no. 3
Dias AR, Sallum RA, Zalc N, Ctenas BB, Ribeiro U, Cecconello I. Squamous cell carcinoma and neuroendocrine carcinoma colliding in the esophagus. Clinics (Sao Paulo) 2010;65:114-7.  Back to cited text no. 4
Chong FK, Graham JH, Madoff IM. Mucin-producing carcinoid (”composite tumor”) of upper third of esophagus: A variant of carcinoid tumor. Cancer 1979;44:1853-9.  Back to cited text no. 5
Nishimaki T, Nakagawa S, Aizawa K, Suzuki T, Hatakeyama K, Watanabe H. Composite tumor of the esophagus with tripartite differentiation. Dig Dis Sci 1997;42:1041-6.  Back to cited text no. 6
Uğraş S, Akpolat N, Er M, Yalçýnkaya I, Karaayvaz M. Primary composite tumour with bipartite differentiation of the esophagus. Acta Chir Belg 2000;100:39-43.  Back to cited text no. 7
Nakagawa S, Nishimaki T, Kanda T, Suzuki T, Hatakeyama K. Composite tumor with papillary adenocarcinoma and squamous cell carcinoma of the esophagus: Report of a case. Surg Today 2000;30:364-7.  Back to cited text no. 8
Lorenceau-Savale C, Pouzoulet J, Le Pessot F, Savoye G, Di Fiore F, Michel P, et al. Composite tumour of the oesophagus revealed by diffuse liver metastasis from its endocrine component. Dig Liver Dis 2006;38:861-2.  Back to cited text no. 9
Bibeau F, Chateau MC, Guiu M, Assenat E, Azria D, Lavaill R, et al. Small cell carcinoma with concomitant adenocarcinoma arising in a Barrett's oesophagus: Report of a case with a favourable behaviour. Virchows Arch 2008;452:103-7.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]

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