Esophageal
small cell carcinoma (SmC) is considered an aggressive
cancer carrying a poor prognosis, although the rarity of this
tumor has impeded statistical evaluation. We reviewed records of 457
esophageal cancer patients treated in our department from 1986 to 2000, comparing clinicopathologic factors and post-treatment outcomes, for 9 patients with SmC, most undergoing
esophagectomy including
lymphadenectomy, with data from 128 patients with
esophageal squamous cell carcinoma (SqC) invading to the muscular layer or beyond. Immunohistochemical features were compared between the SmC and 12 consecutive SqC. All patients studied had localized disease according to preoperative staging. SmC showed more ulcerative and infiltrative growth, and more aggressive lymphatic spread, than SqC. All SmC patients had
lymph node metastasis (thoracic nodes, 9 patients: abdominal 6; cervical 1). All SmC specimens but no SqC were immunoreactive for
neuron-specific enolase. Two and three SmC specimens were reactive for
epithelial membrane antigen and
keratin, respectively. Survival of SmC patients after
esophagectomy (median, 11 months) was worse than for SqC patients (p=0.013). However, 1 SmC patient remains alive at 76 months. Survival was not related to any clinicopathologic or immunohistochemical features. While SmC shows aggressive behavior and worse outcomes than SqC, combining
esophagectomy with
chemotherapy or
radiotherapy may prolong survival.