Co-existence of early esophageal carcinoma and leiomyoma: a case report

There have been several reports of co-existing esophageal squamous cell carcinoma and esophageal submucosal tumor. However, there is no previous report describing a submucosal tumor located within an area of early esophageal cancer. This report presents the case of a 64-year-old man who developed early esophageal cancer with leiomyoma situated within the lesion in the upper third of the esophagus. Since leiomyoma existed within the area of the esophageal cancer, it was misdiagnosed as a component of esophageal cancer and the depth of esophageal cancer invasion was overdiagnosed by endoscopic ultrasonography. Therefore, surgery was chosen as treatment for esophageal cancer. If the leiomyoma had been diagnosed correctly as a submucosal tumor by endoscopy and endoscopic ultrasonography, an endoscopic mucosal resection would have been the therapeutic procedure of choice for an esophageal tumor.     

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.     

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

Reported is a case of 61-year-old man with a superficial esophageal cancer that was associated with an intramural metastasis to the stomach. Examination of the upper G.I. tract revealed a slightly elevated lesion with an irregular surface at the left wall of the lower esophagus, and a large submucosal tumor with an ulcerous formation that had developed and had increased rapidly within a month. Thus a resection of the lower esophagus and a total gastrectomy were performed. Histopathologically, the tumor of the lower esophagus was determined as being a moderately differentiated squamous cell carcinoma with a deep invasion to the submucosal tissue. The submucosal tumor of the stomach also was found to be a moderately differentiated squamous carcinoma. Neither provided evidence, however, of a direct involvement of the gastric serosa may have metastasized from the neighboring lymph nodes or from other organs, nor of any continuous mucosal metastasis between the primary lesion of the esophagus and the submucosal tumor of the stomach. Judging from these findings, the case was diagnosed as an esophageal cancer with an intramural metastasis to the stomach.     

内镜下黏膜剥离术治疗早期食管癌及癌前病变的临床应用

目的探讨内镜黏膜剥离术（ESD）在早期食管癌及癌前病变治疗中的应用价值与意义。方法选取2007年1月至2010年1月57例行内镜检查取活检经病理学确诊的早期食管癌及癌前病变并行ESD治疗的患者,进行内镜下黏膜剥离术,对照术前与术后的病理结果,并对手术并发症、治疗效果及预后进行观察。结果57例行ESD治疗的早期食管癌及癌前病变患者,术后病理学诊断黏膜内癌12例（21．1％）,原位癌22例（38．6％）,重度不典型增生18例（31．6％）,中度不典型增生5例（8．8％）。术前术后病理学诊断符合率为87．6％,其中有10例不相符的患者为术前活检病理级别低于术后病理级别。结论对于病理学活检、染色内镜及超声内镜确诊为直径〈30mm无肿瘤转移的早期食管癌及中重度异型增生患者进行内镜下黏膜切除术效果良好。黏膜下剥离术是这类早期食管癌及癌前病变治疗的有效方法,且创伤小,能有效提高患者术后生活质量,值得临床推广应用。     

Superficial Carcinoma of the Esophagus Coexisting with Esophageal Leiomyoma: A Case Report and Review of the Japanese Literature

A case of superficial spreading squamous cell carcinoma locatedjust over a leiomyoma is presented. The patient complained ofslight dysphagia and an esophagogram showed an elevated tumorin the middle thoracic esophagus. Esophagoscopy revealed anulcerative mucosal lesoin over the elevated lesion and biopsyshowed that the lesion was a squamous cell carcinoma. Bluntdissection of the esophagus with esophago-gastro-anastomosiswas performed. There was neither lymph vessel invasion nor lymphnode metastasis. His postoperative recovery was satisfactoryand he is doing well two years after the operation. A reviewof the Japanese and English literature revealed that a few casesof esophageal carcinoma coexisting with esophageal leiomyomahave been reported. There was no report of superficial esophagealcarcinoma coexisting with esophageal leiomyoma. This is thefirst report of the coexistence of these two lesions, and esophagoscopyis necessary to find a superficial esophageal carcinoma coexistingwith esophageal leiomyoma.     

Histopathologic characteristics of early stage esophageal carcinoma. A comparative study with gastric carcinoma.

Unlike the stomach, the esophageal mucosal layer has abundant vessels. To study the histopathologic character of cancer of the esophagus in comparison with that of stomach, the histologic findings (such as vascular or lymphatic permeation and lymph nodal involvement of cancer) were surveyed in 52 lesions of superficial esophageal carcinoma in which carcinoma invasion was limited to the submucosal layer, 448 cases of so-called early gastric carcinoma in which the carcinoma invasion was limited to the submucosal layer, and 109 cases of gastric carcinoma invading the proper muscle layer (PM-carcinoma). With respect to lymph node metastasis and lymphatic and vascular permeation, there was a particularly high incidence of carcinoma extending to the submucosal layer (SM-carcinoma) of the esophagus and a similar high incidence of PM-carcinoma of the stomach. Carcinoma limited to the mucosal epithelium and mucosal layer of the esophagus (MM-carcinoma) has an incidence similar to carcinoma in the mucous membrane and SM-carcinoma of the stomach, respectively. Thus, the cases in which carcinoma invasion was limited to the muscle layer of the mucosa of the esophagus were shown to have a prognosis similar to that of so-called early carcinoma of the stomach.     

Primary adenoid cystic carcinoma of the esophagus: report of a case.

A case of primary adenoid cystic carcinoma of the esophagus is reported. A 51-year-old male patient had a tumor in the lower third of the esophagus which was incidentally found during an examination for cholelithiasis, and resected successfully. The tumor exhibited a polypoid appearance covered by normal esophageal epithelium, localized entirely in the submucosal layer, and morphologically identical to adenoid cystic carcinoma in the salivary glands. The patient is still alive and well three and one-half years after surgery. This seems to be a typical case of adenoid cystic carcinoma of the esophagus arising from the submucosal esophageal gland.     

20例食管癌肉瘤的诊断与治疗分析

目的食管癌肉瘤是一种罕见病,通过回顾分析本组较大样本食管癌肉瘤的病理及临床特点,探讨其诊断治疗.方法对20例食管癌肉瘤病人的临床资料进行回顾性分析.结果食管癌肉瘤多为覃伞样、息肉样腔内生长,个别呈浸润生长.光镜下肉瘤与癌两种成份共存,瘤体以肉瘤成分为主,表面及蒂多分布癌组织,活检常显示为鳞癌,故术前多不能明确诊断.20例患者中9例侵犯粘膜层,1例浅肌层,4例深肌层,6例侵犯外膜.4例出现淋巴结转移,淋巴转移率20%,转移成分3例鳞癌,1例肉瘤.手术切除率100%.1、3、5年生存期分别为85%、68%、68%.结论食管癌肉瘤是一种低侵袭性,低淋巴转移率,预后尚佳的肿瘤.X线表现为食管腔内息肉样的充盈缺损,轮廓较为光滑整齐,粘膜显示"涂抹征".食管镜活检多显示鳞癌或低分化癌,术前难以确诊.治疗以手术切除为主,必要时辅以放化疗.     

食管平滑肌瘤的外科治疗

目的　探讨食管平滑肌瘤的诊断方法、手术时机与手术方式的选择以及手术并发症的预防。方法总结 70例食管平滑肌瘤外科治疗的临床资料 ,结合文献复习 ,进行回顾分析。结果　全组病例术前经选择性地采用食管造影、食管镜、食管腔内超声、胸部CT扫描等方法检查 ;除因肿瘤 <1 0cm、无症状或症状轻微 ,合并症禁忌以及患者拒绝共 10例未手术外 ,手术治疗 6 0例 ;病理证实为平滑肌瘤 5 6例 ,平滑肌肉瘤 3例 ,平滑肌瘤合并食管鳞癌 1例 ;手术方式包括 :经胸前外或后外侧切口、腋窝S切口、不切断肌肉胸壁小切口、胸膜外及胸腔镜下粘膜外肿瘤摘除 ,食管部分切除、食管胃重建附加幽门成形术 ;术中食管粘膜破损 7例 ,术后声音嘶哑、食管狭窄各 1例 ,无围手术期死亡。结论　钡剂食管造影、食管镜检查仍为食管平滑肌瘤的基本、有效诊断方法。食管腔内超声探测、胸部CT扫描对于X线表现不典型、与恶性病变难以鉴别的病例 ,具有重要意义 ;基于食管平滑肌瘤系良性病变 ,提出对于病变小于 1 0cm、症状轻微、术中难以定位的患者 ,仅作追踪观察对象 ;对于体积较大、症状明显、或疑有恶性变者应根据肿瘤部位、大小、及性质确定手术入路及方案进行手术。强调术前如考虑为平滑肌瘤时 ,内镜下不宜咬取活检 ;术中剥离肿瘤时 ,应紧     

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.     

胃大部切除术后食管癌的外科治疗

目的：探讨胃切除术后食管癌的外科手术治疗。方法：通过我科的39例手术,结合文献分析胃大部切除术后食管癌手术切除重建的各种术式方法及优缺点。结果：上段食管癌切除应以横结肠代食管重建为佳,中下段食管癌以残胃代食管重建最理想,也可以用空肠代食管重建。结论：胃大部切除术后食管癌是可以通过手术再根治的,食管的重建以残胃最接近生理及解剖学,术式简单,安全,易行。     

An associated concomitant early multiple esophageal carcinoma and gastric carcinoma

Presented is the case of a 71-year-old female with an associated, concomitant early multiple esophageal carcinoma and a gastric carcinoma. An esophageal endoscopy revealed a reddish region in the upper and middle esophagus. This lesion, in part, remained unstained by lugol. Further, three lesions were observed at the upper and middle portions of the esophagus in a resected specimen, and the macroscopic diagnosis was 0-II c, These lesions were histologically diagnosed as being moderately differentiated squamous cell carcinomas, 5 x 15 mm, 2 x 5 mm, and, 3 x 5 mm in size. Furthermore, a lesion in the cardia was found superimposed on the esophageal cancer, and diagnosed as being an adenocarcinoma (II b), 10 x 15 mm in size. In the literature, reports of a concomitant association of an early esophageal carcinoma and a gastric carcinoma amount to 19 cases in Japan, our case being the twentieth case. In formatively, our case was found to display a multiple carcinoma in the esophagus.     

我国食管癌放射治疗进展

食管癌是我国常见的恶性肿瘤之一,早期诊断滞后,确诊时80%的病例局部病灶已很广泛或远处转移。放射治疗是食管癌治疗最主要手段之一。本文介绍近年来我国在食管癌放射治疗和多学科综合治疗方面进展,包括单纯放射治疗、放疗与手术、放疗与化疗、放疗与腔内热疗综合治疗的进展。     

下咽和食管异时性重复癌

重复癌是指同一宿主在同一器官或成对器官、同一系统不同部位以及不同器官同时或先后发生〉2个的原发恶性肿瘤。本文报道1例下咽和食管异时性重复癌,其中下咽癌发现于食管癌术后内镜复查阶段,临床分期处于T1N0M0。已有学者建议可应用内镜下黏膜剥离术治疗早期下咽癌,有望获得良好治疗效果。因此,该重复癌病例提示内镜医生在常规胃镜检查时除仔细观察食管、胃以及十二指肠部位病变外,还应注意咽喉部特别是梨状隐窝等罕见部位的可疑早期癌变,并且可以应用新型内镜技术提高早期下咽癌的检出率,延长患者的生存期。     

A case of successful treatment by low-dose 5-fluorouracil and cisplatin for liver metastases of esophageal adenosquamous carcinoma

Adenosquamous carcinoma of the esophagus is an uncommon type of esophageal tumor. In the present case, a 54-year-old man without symptoms was diagnosed with esophageal squamous cell carcinoma, based on endoscopic examination of a biopsy specimen. Endoscopy and barium roentgenography revealed a superficial plateau-type lesion, 2 cm in length, in the lower esophagus. Esophagectomy with lymphadenectomy was performed via a right thoraco-abdominal approach. The histological diagnosis was adenosquamous carcinoma with no lymph node metastasis. Three years after the surgery, multiple liver metastases were detected by computed tomography. The patient was treated with a combination of low-dose 5-fluorouracil(350 mg/body/day) and low-dose cisplatin (7 mg/body/day). Because the first course of chemotherapy was very effective and the number of liver metastases was reduced,a further 6 courses were administered. After 6 courses of chemotherapy, no liver metastases were detected. Based on the present findings, we recommend low-dose 5-fluorouracil/cisplatin therapy for liver metastasis from esophageal adenosquamous carcinoma.     

MSCT充气造影检查对食管疾病的诊断价值

目的：探讨多层螺旋CT（MSCT）充气造影检查对食管疾病的诊断价值。方法选择100例经胃镜及手术病理证实的食管疾病患者,均行MSCT充气造影检查,将扫描后的图像进行薄层重建及后处理,对MSCT充气造影结果与病理结果进行比较,并采用Kappa检验分析其一致性。结果100例食管疾病患者中,经消化胃镜及术后病理证实,食管平滑肌瘤62例,食管癌8例,食管憩室6例,食管囊肿8例,隆突下增大淋巴结结核2例,食管血管瘤4例,正常食管10例。所有患者均顺利完成MSCT充气造影检查,食管管腔扩张良好。经Kappa检验,MSCT充气造影结果与病理结果具有良好的一致性（Kappa值=0.898,P﹤0.001）。MSCT充气造影诊断食管平滑肌瘤的特异度、灵敏度和准确率分别为96.8%、78.9%、90.0%,诊断食管癌的特异度、灵敏度和准确率均为100%。结论 MSCT充气造影检查作为一种诊断食管疾病的新方法,有利于提高食管疾病的检出率,在临床中具有重要的应用价值。     

胃大部切除术后食管癌的外科治疗

目的:探讨胃切除术后食管癌的外科手术治疗。方法:通过我科的39例手术,结合文献分析胃大部切除术后食管癌手术切除重建的各种术式方法及优缺点。结果:上段食管癌切除应以横结肠代食管重建为佳,中下段食管癌以残胃代食管重建最理想,也可以用空肠代食管重建。结论:胃大部切除术后食管癌是可以通过手术再根治的,食管的重建以残胃最接近生理及解剖学,术式简单,安全,易行。     

Superficial small cell carcinoma of esophagus treated by endoscopic mucosal resection combined with chemoradiotherapy--a case report

The patient was a 70-year-old woman who was admitted to our hospital for positive fecal occult blood. Upper gastrointestinal endoscopy revealed a superficial plateau-type (0- I sep) submucosal cancer on the right wall of the esophagus 28 cm from the incisor. Biopsy revealed small cell carcinoma. CT scan detected neither lymph node metastasis, nor distant organ metastasis. Endoscopic mucosal resection (EMR) was performed. Post-EMR chemoradiotherapies were conducted. The patient has lived with no evidence of cancer recurrence for 40 months. This was the first case of esophageal small cell carcinoma treated by EMR combined with chemoradiotherapy.     

食管平滑肌瘤的诊断及外科治疗

目的　探讨食管平滑肌瘤的诊断及外科治疗特点。方法　对 14 1例食管平滑肌瘤患者的术前影像学、内窥镜资料及外科治疗结果进行回顾性分析。结果　食管平滑肌瘤患者的主要症状为吞咽不顺 (6 4 .5 % )及胸部或上腹部疼痛 (2 0 .6 % ) ,平均病史 15 .7个月。 11例术前误诊为食管恶性肿瘤、纵隔或腹膜后肿瘤。 13例行食管部分切除术 ,其中 2例肿瘤巨大 ,3例术中仍误诊为食管恶性肿瘤 ,8例并存食管癌或贲门癌。 12 8例行肿瘤摘除术 ,13例术中黏膜破裂并予以修补。肿瘤单发 130例 ,多发 11例。瘤体呈类圆形、马蹄形或不规则形 ,包绕食管周经 <1/ 2者 75例 ,>1/ 2者 5 9例 ,累及全周者 7例。肿瘤呈息肉状管腔内生长 1例 ,管壁外生长 2例 ,其余均管壁内生长。本组无手术死亡 ,手术并发症发生率 3.6 %。结论　食管平滑肌瘤易误诊为食管恶性肿瘤或纵隔肿瘤 ,应注意鉴别诊断。术式选择应尽可能行肿瘤摘除术。食管镜检查疑为平滑肌瘤时应避免活检。食管平滑肌瘤患者食管癌发病率较高 ,其原因有待探讨     

贲门失弛症并发食管癌与贲门癌

目的提高贲门失弛症并发食管、贲门癌的诊断和治疗水平.方法回顾12例贲门失弛症伴发食管、贲门癌的诊断治疗和病理.结果 12例贲门失弛症伴发食管、贲门癌病例中,手术治疗4例,其中2例生存超过3年.1例于手术后半年死亡,1例术后不足半年,放化疗6例,均于半年至一年半内死亡.结论 1.食管、贲门癌易被贲门失弛症的症状所掩盖.2. Heller手术并不能降低食管癌的发生率,应每年随访1次. 3.贲门失弛症伴发食管癌发生比率较高,也是食管癌的高发人群.4 .术后病人如有症状早就诊可以早期发现.5 .同时发生癌和异时发生癌的机会相近.Heller术前应常规内镜检查排除食管贲门癌以防漏诊.