Esophageal Squamous Cell Carcinoma with Ductal Differentiation

Area of Science:

• Oncology
• Gastroenterology
• Pathology

Background:

• Esophageal squamous cell carcinoma with ductal differentiation (ESCC-DD) is an exceptionally rare subtype of esophageal cancer.
• Understanding the histogenesis and clinical behavior of ESCC-DD is crucial for effective patient management.
• Limited case reports exist, highlighting the need for further clinical and pathological analysis.

Purpose of the Study:

• To present a rare case of esophageal squamous cell carcinoma with ductal differentiation (ESCC-DD).
• To analyze the histopathological features, clinical presentation, and treatment response of this rare esophageal cancer.
• To discuss the potential histogenesis of the biphasic glandular structures observed in ESCC-DD.

Main Methods:

• Case report of a 61-year-old male patient with progressive dysphagia.
• Diagnostic workup included imaging studies, endoscopy, and pathological examination of biopsy specimens.
• Treatment involved chemotherapy (albumin-bound paclitaxel plus cisplatin), immunotherapy (sintilimab), and subsequent esophagectomy. Immunohistochemical and special staining were used for histopathological analysis.

Main Results:

• Pathological examination revealed moderately differentiated squamous cell carcinoma with focal biphasic glandular structures.
• The patient showed significant improvement in dysphagia and reduced esophageal wall thickening after neoadjuvant therapy.
• Postoperative pathology confirmed residual carcinoma with minimal treatment response (Grade 2), lymph node metastasis, and suggested aberrant differentiation of submucosal gland ducts as the origin of the glandular structures.

Conclusions:

• Esophageal squamous cell carcinoma with ductal differentiation (ESCC-DD) presents unique histopathological challenges.
• Combined chemotherapy and immunotherapy demonstrated clinical benefit, although with a minimal treatment response at the primary tumor site.
• Aberrant differentiation of esophageal submucosal gland ducts is a plausible hypothesis for the histogenesis of biphasic glandular structures in ESCC-DD.