Small cell carcinoma of the esophagus: evidence for a unified histogenesis

Four cases of small cell carcinoma of the esophagus, histologically indistinguishable from oat cell carcinoma of the lung, were studied by electron microscopy. Three were composed largely of small cells with neurosecretory granules characteristic of APUD (amine precursor uptake and decarboxylation) cells. Two of these three cases also contained foci of squamous or glandular differentiation, or both. The fourth case was classified as reserve cell carcinoma with squamous differentiation, since the tumor cells were devoid of neurosecretory granules but contained desmosomes and bundles of intracytoplasmic tonofilaments. The evidence provided by these four cases and also by the 48 cases previously reported in the literature supports our hypothesis that a totipotent primitive cell serves as the common precursor for squamous cell, adeno-, and small cell carcinoma of the esophagus. The latter can be subdivided into oat cell and reserve cell carcinomas, both having the propensity for further squamous and glandular differentiation. The hypothesis can also be applied to lung cancer.