Co-Incidence of Fibrosarcoma and Esophagus Squamous Cell Carcinoma; a Case of Synchronous Second Primary Neoplasm



Arani RH¹ ; Daryani NE¹ ; Aletaha N¹ ; Avanaki FA¹
Source: Govaresh Published:2021

Abstract

Fibrosarcoma is one of the least common primary malignant tumors of skeleton-formative tissue. Also, primary esophagus squamous cell carcinoma (SCC) is a rare tumor accounting for 0.05–4% of all esophageal malignancies with aggressive behavior and poor prognosis. In this study, we aimed to present a 40-year-old man with the co-incidence of SCC and fibrosarcoma. Case presentation: A 40-year-old man presented to the gastrointestinal clinic of Imam Khomeini Hospital Complex complaining about a three-month abdominal pain and progressive dysphagia. He also complained of severe pain in both flanks, dark color urine with blood clots, and a 10-kg weight loss in the past two months. A spiral CT scan revealed a 14×15×13 cm3 lobulated solid mass in the right side of the pelvic. The pathology described malignant neoplastic tissue composed of cells with large hyperchromatic pleomorphic nuclei. Fibrosarcoma was diagnosed according to immunohistochemistry (IHC) results and morphology. The endoscopy noted a 5 cm ulcerative mass in the esophagus, which occupied less than 50% of the lumen. The pathology showed squamous cell carcinoma from the esophageal mass biopsy. Diagnostic laparoscopy denied any peritoneal seeding and liver or kidney metastases. We planned to conduct neoadjuvant chemoradiotherapy (cisplatin plus etoposide, and 40Gy external beam radiation therapy) and surgery for his esophageal SCC and radiotherapy for Fibrosarcoma. This is the first report of the second primary esophageal SCC after fibrosarcoma in a 40-year-old man with no noticeable predisposing factor (such as smoking, immune modulator drug, radiation exposure, etc.). Further studies are needed for developing intervention strategies to reduce the risk or to improve the treatment of multiple primary neoplasms. © 2021 Iranian Association of Gastroenterology and Hepatology. All rights reserved.