Early esophageal cancer concomitant with leiomyoma of the esophagus--a case report

Benign esophageal tumors concomitant with esophageal cancer are sometimes observed, however, it is rare that esophageal cancer is associated at the surface of the leiomyoma as a submucosal tumor. We report a 59-year-old man with a polypoid esophageal cancer. The polypoid tumor, 0.6 X 0.7 X 1.3 cm in size, was removed in 1976; histological findings showed that a large amount of the tumor was leiomyoma and that squamous cell cancer was associated at the surface of the leiomyoma. After polypectomy, he experienced recurrence and radical surgery was performed in 1981; histologically, the resected specimen showed early esophageal cancer.     

A surgical case of submucosal esophageal carcinoma with esophageal leiomyoma misdiagnosed as esophageal

A 56-year-old man with submucosal esophageal carcinoma combined with esophageal leiomyoma is presented. He had suffered from progressive dysphagia and vomiting. X-ray and endoscopic examination revealed severe stenosis of the lower esophagus with smooth mucosa, and CT scan demonstrated a circular and localized tumor. The histological diagnosis of esophageal leiomyoma was made by means of surgical biopsy. Resection of the lower esophagus and upper stomach was performed. But the postoperative pathological examination revealed submucosal esophageal squamous cell carcinoma combined with esophageal leiomyoma. The etiology and diagnosis in this case were discussed.     

Endoscopic options for early stage esophageal cancer

Surgery has traditionally been the preferred treatment for early stage esophageal cancer. Recent advances in endoscopic treatments have been shown to be effective and safe. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopists to remove small, superficial lesions, providing tumor specimen that can be examined for accurate pathologic tumor staging and assessment of adequacy of resection. Endoscopic ablation procedures, including photodynamic therapy (PDT) and radio frequency ablation (RFA), have also been shown to safely and effectively treat esophageal dysplasia and early stage neoplasia, with excellent long-term disease control. Both approaches are becoming more widely available around the world, and provide an alternative, safe, low risk strategy for treating early stage disease, making combined endoscopic therapy the recommended treatment of choice for early stage esophageal cancers.     

窄带成像放大内镜诊断早期食管癌的临床价值研究

目的 探讨窄带成像放大内镜(NBI-ME)诊断早期食管癌的临床价值.方法 选取2018年1月至2021年1月间上海市金山区亭林医院收治的经病理证实的200例高级别上皮内瘤变或早期食管癌患者,采用随机数表法分为普通内镜组、超声内镜组、NBI-ME组和窄带成像(NBI)-碘染色内镜组,每组50例.普通内镜组患者采用普通内镜...     

ESD及STER在食管平滑肌瘤治疗中的应用

目的研究内镜黏膜下剥离术（ESD）及内镜黏膜下隧道肿瘤切除术（STER）在食管平滑肌瘤治疗中的应用价值。方法回顾性分析22例经ESD或STER治疗、术后病理及免疫组化确诊为食管平滑肌瘤的患者的基本情况、病变部位、临床表现、治疗情况、组织学特征以及术后随访结果。结果14例经ESD治疗,8例经STER治疗。超声内镜示病变位于黏膜肌层9例,固有肌层13例。CT检查阳性率27．27％。所有病变均一次性完整切除。手术切除肿瘤大小为0．2～3．0cm,平均（1．35±0．78）cm。STER组的手术时间（51．50±7．61）min,比ESD组的（81．64±6．57）min短,差异有统计学意义（P=0．009）;术中出血量STER组（50．00±8．66）mL,比ESD组的（81．42±7．10）mL少,差异有统计学意义（P=0．013）。SMA及Desmin检测阳性率均为100．00％,CD117灶阳性率为68．18％,CD34血管阳性率为45．45％,DOG-1阳性率为9．09％,Ki-67为〈5％阳性。除1例患者STER术后出现食管脓肿,余2l例患者均未出现并发症,所有患者2个月后复查恢复良好,无复发。结论STER和ESD均可用于食管平滑肌瘤的治疗,相比ESD,STER在手术时间及术中出血量上更有优势,有望成为治疗黏膜下肿瘤（尤其是起源于固有肌层）的主要方法。     

高频超声内镜在食管癌高发区早期癌及癌前病变诊治中的价值

  目的  探讨超声内镜在食管癌高发区早期癌及癌前病变诊断及治疗中的价值。  方法  回顾分析2008年6月至2010年6月在食管癌高发区涉县、磁县进行普查发现的118例早期食管癌及癌前病变患者, 所有病例均行超声内镜(endoscopic ultrasonography, EUS)检查, 符合镜下治疗标准的内镜辅以碘染色并行内镜下黏膜切除术(endoscopic mucoscal resection, EMR), 余手术治疗。对所有行EMR术及手术治疗的患者术前EUS及术后病理结果进行对照分析。  结果  EUS判断食管早期癌及癌前病变影像学结果显示: 黏膜层癌97例、黏膜下层癌21例, EUS与病理检查结果对照判断浸润深度, 结果相符者103例, 准确率87%, 其中对黏膜层癌判断的准确率90%, 对黏膜下层癌判断的准确率76%。  结论  EUS准确评估病灶内镜可切除性, 使得内镜下黏膜切除手术更为安全有效, 对指导高发区早期食管癌和癌前病变内镜下治疗具有重要价值。      

Esophageal metastasis of breast carcinoma

Esophageal metastasis from primary breast cancer is an unusual manifestation. We recently treated a patient with dysphagia, whose breast cancer had been treated in the distant past. A 70-year-old woman had been followed regularly in our outpatient clinic for 14 years after her primary breast cancer treatment, with no apparent tumor recurrence. After 2 years absence, she consulted our clinic with progressive dysphagia. Contrast esophagography and endoscopic examination with ultrasonography revealed a protruding submucosal tumor that was histopathologically diagnosed as esophageal metastasis of breast cancer. Radiation therapy involving a total of 60 Gy in combination with aromatase inhibitor was given. The patient’s dysphagia was greatly relieved, concomitant with marked improvement of the stenotic lesion on imaging. Since treatment for recurrent breast cancer is generally palliative, systemic (chemo- and/or endocrine-) therapy in combination with radiotherapy is the first-line option for esophageal metastasis of breast cancer.     

Determination of the resection line in early esophageal cancer using intraoperative endoscopic examination with Lugol staining.

Determination of the resection line using intraoperative endoscopic examination with Lugol staining was performed when preoperative examinations such as an esophagogram could not be effectively carried out and the carcinoma was not palpable from the outer surface of the esophageal wall. During the past two years, we performed this technique on eight patients. The carcinoma was restricted within the epithelium in one, the mucosal layer in five, and the submucosal layer in two. Although intraepithelial carcinoma contiguous to the main lesion was seen in six and cancer multiplicity was evident in two, all of the resected stumps were free of any cancer tissue. There have been no cases of recurrence and a limited operation, such as distal esophagectomy, was able to be performed in six. Therefore, intraoperative endoscopic examination is useful for early esophageal cancer.     

Endoscopic assessment and management of early esophageal adenocarcinoma

Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion.     

术前超声内镜对早期胃癌浸润深度的诊断价值及其影响因素分析

[目的]探讨超声内镜对早期胃癌浸润深度诊断的准确性及影响因素分析。[方法]回顾性分析2012-2013年行术前超声内镜检查且超声内镜分期为T1、术后获得明确病理诊断为早期胃癌临床病例138例,比较超声内镜与病理判断肿瘤黏膜下浸润的一致性,以及影响超声内镜分期准确性的相关因素。[结果]在138例病例中,超声内镜诊断黏膜下层受侵与否的准确率为71.74%,特异性为76.67%,灵敏度为62.5%。肿瘤大小和分化程度与过度分期和分期不足相关。[结论]对早期胃癌浸润深度的诊断,超声内镜具备临床应用价值。肿瘤大小、病理分化程度影响术前超声内镜分期的准确性。     

Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making

BACKGROUND: As an alternative to surgical resection, endoscopic treatment modalities are being explored for the treatment of patients with early esophageal carcinoma. This study aimed to evaluate patterns of local growth and regional dissemination of early adenocarcinoma of the esophagus or esophagogastric junction, as these pathologic features may contribute to rational therapeutic decision making. METHODS: Among 173 patients who underwent esophageal resection for invasive adenocarcinoma (1993-1998), 32 (19%) had early stage cancer (pT1). Clinical records, pathology reports, and original slides of the surgically resected esophagus were reviewed in each case. RESULTS: In 12 patients tumor invasion was limited to the mucosa, whereas in 20 patients the tumor showed infiltration of the submucosa. All cancers were associated with intestinal metaplasia. Areas of high grade dysplasia accompanied 27 of the 32 cancers (84%). Intramucosal cancer had no lymph node metastasis but presented as multifocal disease in 42% of cases and extended under preexisting squamous mucosa in 17% of cases. In submucosal cancer, lymph node metastases were present in 30% of cases. Disease specific 3-year survival for patients with intramucosal cancer was 100% and for those with submucosal cancer 82% (P = not significant). CONCLUSIONS: Based on the local growth pattern of intramucosal adenocarcinoma of the esophagus or esophagogastric junction, endoscopic treatment of patients with this disease should be applied with caution. For submucosal carcinoma, surgery is the mainstay of treatment, as lymph node metastasis is frequently present. Both subclassifications of early cancer show a favorable outcome after esophagectomy.     

A case of superficial esophageal cancer with metastasis to the gastric wall

A 65-year-old man with superficial esophageal cancer associated with gastric wall metastasis is presented. He had suffered from epigastralgia and dysphagia for two months. X-Ray and endoscopic examination revealed esophageal erosion at the right wall of the lower esophagus and a large gastric submucosal tumor at the lesser curvature of the upper and middle stomach. Resection of the lower esophagus and total gastrectomy were performed. Histologically, the erosion of the lower esophagus was moderately differentiated squamous cell carcinoma invading as deep as the submucosal tissue and the tumor of the stomach was metastasis of the esophageal cancer. Intramural metastasis of esophageal cancer was discussed.     

多模态影像技术在食管癌放射治疗中的研究进展

食管癌是常见的消化道恶性肿瘤,但早期常无典型症状,临床诊断时多已发展为中晚期,错过了手术治疗的最佳时机。因此,如何能在早期诊断食管癌、获取到肿瘤更全面的信息一直是备受关注的问题。目前常用于食管癌早期诊断和疗效评估的影像技术有:电子计算机断层扫描（computed tomography,CT）、磁共振成像（magnetic resonance imaging,MRI）、超声内镜（endoscopic ultrasonography,EUS）、正电子发射计算机体层摄影（positron emission tomography,PET）,本文就近年来多模态影像技术在食管癌放射治疗中的研究进展做一综述。     

A new endoscopic classification system of early-stage esophageal carcinoma and its usefulness in assessing the infiltration depth of esophageal carcinoma

The growth pattern, height, and depth of early esophageal carcinoma were observed under gastroscopy and endoscopic ultrasonography. The infiltration depth of carcinomas was determined pathologically. Early esophageal carcinomas were classified into five types by endoscopy: surface propagating growth, intraluminal growth, intramural growth, bilateral growth, and mixed growth. Intramucosal and submucosal carcinomas were differentiated on the basis of the different types, height of intraluminal growth and bilateral growth, and depth of intramural growth type. The accuracy of differentiate diagnosis was 87.2%. Our results indicate that this new endoscopic classification system can accurately differentiate intramucosal and submucosal infiltration of early-stage esophageal carcinomas.     

Extent of surgical resection for esophageal and gastroesophageal junction adenocarcinomas

The early-stage lymphatic dissemination in esophageal cancer poses challenges for adequate surgical treatment. The role of extensive lymph node dissections remains a matter of debate. Results of the only available large randomized controlled trial suggest that fit patients who have esophageal cancer are treated best by a transthoracic esophagectomy with extended en bloc (two-field) lymphadenectomy. For less fit patients or patients who have junctional or cardiac tumors, transhiatal esophageal resection could suffice. In patients who have truly "early" adenocarcinoma (ie, with high-grade dysplasia or intramucosal carcinoma) endoscopic resectional or ablative treatments may be suitable. When the tumor invades the submucosal layer, the high risk for lymph node involvement and tumor recurrence probably necessitates more extensive treatment schedules for definitive cure.     

Ulcerous Change Decreases the Accuracy of Endoscopic Ultrasonography Diagnosis for the Invasive Depth of Early Gastric Cancer

Background

With the development of endoscopic submucosal dissection, an expansion of the criteria for local treatment was suggested for lesions with ulcerous changes or undifferentiated-type adenocarcinoma.

Aim of the Study

To determine the efficacy of endoscopic ultrasonography for such lesions, we retrospectively analyzed factors that influenced accurate diagnosis by endoscopic ultrasonography of the depth of tumor invasion.

Methods

We investigated 267 gastric adenocarcinomas for which histopathological results were obtained by endoscopic mucosal resection or gastrectomy. The lesions were divided into four groups by histological type and the presence of ulcerous changes. Five clinicopathological factors were assessed for their possible associations with incorrect diagnosis.

Results

The positive predictive value (PPV) for cancer limited within the mucosa (endoscopic ultrasonography, EUS-M) and cancer invaded into the submucosal layer (EUS-SM) were 88.0% (125 of 142 lesions) and 60.0% (30 of 50 lesions), respectively. The lesions diagnosed as EUS-M/SM borderline (37 lesions) included 19 lesions (51.4%) of M cancer and 17 lesions (45.9%) of SM cancer. In logistic analysis, ulcerous changes (p?<?0.0001) and macroscopic classification (p?=?0.0284) were factors that caused incorrect diagnosis by endoscopic ultrasonography. In the group having differentiated-type adenocarcinoma with ulcerous changes, the PPV of EUS-SM was 25% (3 of 12), and there was a significant difference (p?<?0.05) between the EUS-SM of this group and that of the differentiated-type adenocarcinoma without ulcerous changes.

Conclusion

The accuracy of endoscopic ultrasonography tumor staging was not sufficient for the lesions with ulcerous changes in our study. Therefore, we should be careful to perform endoscopic submucosal dissection for lesions with ulcerous changes.     

Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer.

PURPOSE: To evaluate the role of endoscopic ultrasonography (EUS) in the initial staging and follow-up of esophageal cancer on the basis of a review of the published literature. METHODS: Articles published from 1985 to 2005 were searched and reviewed using the following keywords: "esophageal cancer staging," "endoscopic ultrasound," and "endoscopic ultrasonography." RESULTS: For initial anatomic staging, EUS results have consistently shown more than 80% accuracy compared with surgical pathology for depth of tumor invasion (T). Accuracy increased with higher stage, and was >90% for T3 cancer. EUS results have shown accuracy in the range of 75% for initial staging of regional lymph nodes (N). EUS has been invariably more accurate than computed tomography for T and N staging. EUS is limited for staging distant metastases (M), and therefore EUS is usually performed after a body imaging modality such as computed tomography or positron emission tomography. Pathologic staging can be achieved at EUS using fine-needle aspiration (FNA) to obtain cytology from suspect Ns. FNA has had greatest efficacy in confirming celiac axis lymph node metastases with more than 90% accuracy. EUS is inaccurate for staging after radiation and chemotherapy because of inability to distinguish inflammation and fibrosis from residual cancer, but a more than 50% decrease in tumor cross-sectional area or diameter has been found to correlate with treatment response. CONCLUSION: EUS has a central role in the initial anatomic staging of esophageal cancer because of its high accuracy in determining the extent of locoregional disease. EUS is inaccurate for staging after radiation therapy and chemotherapy, but can be useful in assessing treatment response.     

高频小探头内镜超声在胃癌术前T分期中的应用价值

背景与目的：内镜超声是目前临床上广泛运用的胃癌术前分期的检查方法。内镜下黏膜切除术及黏膜剥离术在治疗早期胃癌中已广泛开展,因此提高胃癌术前分期的准确性,尤其是早期胃癌的诊断率。本文旨在探讨高频小探头内镜超声（high frequency endoscopic ultrasound mini probe,UMP）在胃癌术前T分期中的临床应用价值。方法：2008年10月—2009年4月,对63例胃癌患者术前分别行高频小探头内镜超声和多层螺旋CT（multislice spiral CT,MSCT）检查,并与手术后病理进行对照。结果：UMP与MSCT对T分期判断准确率分别为82.26%（51/62）和88.71%（55/62）,差异无统计学意义（P〉0.05）。UMP与MSCT对早期胃癌的诊断准确率分别为100.00%和88.89%;进展期胃癌的诊断准确率则是79.25%和88.68%。结论：UMP对早期胃癌诊断具有重要价值,因此对于内镜下查找浅表病灶应首选UMP。     

A case of esophageal squamous cell intraepithelial neoplasia with positivity for type 16 human papillomavirus successfully treated with radiofrequency ablation

Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. Our report might give further strength to the hypothesis of an etiological role of HPV in selected cases of esophageal carcinogenesis and opens a discussion on the possible use of Radio Frequency Ablation as an effective and safe endoscopic treatment for both early squamous cell neoplasia and HPV esophageal colonization.     

Esophageal skip metastasis from an adenocarcinoma of the gastric cardia

Although diffuse‐type gastric carcinomas sometimes spread within the esophageal mucosa, a distant skip metastasis from a gastric carcinoma to the esophagus wall has rarely been reported. We herein report the case of a patient found to have a carcinoma of the gastric cardia with a skip metastasis to the esophagus, approximately 10 cm distant from the esophagogastric junction. A 53‐year‐old man was admitted to our department suffering from a sudden hematemesis. An upper gastrointestinal endoscopic study revealed an infiltrative ulcerating tumor of the gastric cardia and a small, reddish, elevated submucosal tumor on the middle third of the esophagus, apart from the tumor on the cardia. A histological study of the biopsy specimens from both tumors showed poorly differentiated adenocarcinomas. The patient underwent total thoracic esophagectomy and proximal gastrectomy combined with a splenectomy through a cervicoabdominal approach. The resected specimen contained a tumor of the cardia, 7.4 × 5.1 cm in area, that had infiltrated the submucosal layers of the lower esophagus up to 2.0 cm from the esophagogastric junction. The skip metastases were located 0.5, 4 and 7.2 cm from the oral side of the main tumor.