A case of small polypoid esophageal carcinoma with multidirectional differentiation, including neuroendocrine, squamous, ciliated glandular, and sarcomatous components

A small composite esophageal carcinoma measuring 1.5 x 1.4 x 1.0 cm is desc ribed. The tumor had a polypoid elevation with a superficial extension. His tologic examination revealed invasion of the submucosal layer and multidire ctional differentiation, including neuroendocrine, squamous, ciliated gland ular, and sarcomatous components. The neuroendocrine component was strongly positive for chromogranin and formed the bulk of the polypoid tumor. The s quamous cell carcinoma exhibited a superficial extension. The adenocarcinom a was located in a small region of the tumor and contained ciliated glandul ar cells. The spindle cell sarcomatous component, which was positive for al pha -smooth muscle actin and negative for cytokeratin, exhibited no specifi c mesenchymal differentiation. Each component was found in 60%, 10%, 5%, an d 25% of the tumor, respectively Cases of small composite esophageal carcin oma containing various carcinomatous and sarcomatous components are extreme ly rare.