Small cell carcinoma with concomitant adenocarcinoma arising in a Barrett's oesophagus: report of a case with a favourable behaviour. Virchows Arch. 2008 Jan;452(1):103-107. Epub 2007 Nov 16.

Most Barrett's oesophagus-associated cancers are adenocarcinomas which occur in a pure form. They are rarely combined with another type of malignancy, such as endocrine tumours. Within the endocrine spectrum, small cell carcinomas (SmCC) usually have a highly aggressive behaviour with a poor prognosis. We report a case of composite SmCC and adenocarcinoma in the setting of a Barrett's oesophagus, in a 54-year-old man. This tumour was identified on a surgical specimen after neoadjuvant treatment with radiotherapy and 5-FU-Cis-platin based chemotherapy. The SmCC component was positive for chromogranin A, synaptophysin, neural cell adhesion molecule and neuron-specific enolase and negative for high molecular weight cytokeratin. The adenocarcinoma component showed a converse phenotype. In our case, the origin of the SmCC component could be explained by the numerous chromogranin A-positive cells observed in the Barrett's oesophagus or by the potential progenitor cells that may be located in the submucosal oesophageal gland ducts and the Barrett's metaplasia. Our report is thus indicative of the high and totipotential risk of Barrett's oesophagus. Moreover, it is particular because of its favourable behaviour, with a 6-year disease-free survival, after neoadjuvant chemoradiation, surgery and postoperative chemotherapy.

Small cell carcinoma of the esophagus: report of a case with review of the literature.J BUON. 2002 Apr-Jun;7(2):161-4.

Primary small-cell carcinoma of the esophagus is a rare tumor that disseminates early and has a uniformly poor prognosis if untreated. We report on a patient with esophageal small-cell carcinoma treated with combination chemotherapy following surgical resection. A 48-year-old female had an ulcerated tumor in the distal part of the esophagus, which was microscopically diagnosed as esophageal small-cell carcinoma. Computed tomography (CT) of the chest and abdomen showed no lymphadenopathy or distant metastatic disease. Chemotherapy plus radiation therapy was planned but the patient refused the proposed treatment due to socieconomic reasons. Subsequently, subtotal esophagectomy with lymphadenectomy (3 periesophageal nodes) was performed in another hospital. The histopathologic diagnosis of the primary tumor was small-cell carcinoma and the resected lymph nodes also contained metastatic deposits. On the second postoperative month she was admitted with hepatic metastases. Combination chemotherapy with etoposide 120 mg/m(2)/day on days 1 to 3, and cisplatin 75mg/ m(2)/day on day 1, given intravenously (i.v.) every 3 weeks was started. After 3 courses, the patient achieved complete remission. Esophageal small-cell carcinoma is an aggressive tumor. Patients with disseminated disease should receive combination chemotherapy along with symptomatic treatment.