Granulocyte colony-stimulating factor-producing esophageal squamous cell carcinoma following chemoradiotherapy and bone marrow transplantation for acute lymphoblastic leukemia

A 30-year-old man, who had been treated with craniospinal irradiation, total-body irradiation, and bone marrow transplantation for acute lymphoblastic leukemia at 20 years of age, complained of dysphagia. The patient had spike fever with leukocytosis (19,020/μl). Serum granulocyte colony-stimulating factor (G-CSF) level was also increased (53.7 pg/ml). Immunohistochemistry revealed positive staining for anti-G-CSF antibody in carcinoma cells obtained by endoscopic biopsy. The patient was diagnosed with G-CSF-producing locally advanced esophageal squamous cell carcinoma. The clinical diagnosis was T4; tumor invaded aorta, with regional lymph node metastases (N1). The patient underwent transthoracic esophagectomy with three-field lymph node dissection and gastric tube reconstruction following a radiation dose of 41.4 Gy with 5-fluorouracil continuous infusion as neoadjuvant therapy. There were no viable cancer cells in the resected esophageal specimen and lymph nodes. The patient had no evidence for typical risk factors for developing esophageal cancer. After the operation, neutrophils and G-CSF decreased to normal levels. The patient had recurrence of regional and distant multiple lymph node metastases at 3 months after operation.     

Surgical resection of solitary adrenal metastasis from esophageal carcinoma following esophagectomy

The prognosis of esophageal carcinoma following esophagectomy is poor due to a high frequency of metastasis to periesophageal lymph nodes and distant organs. However, we experienced a case with good prognosis following resection of a solitary adrenal metastatic tumor. The patient was a 70-year-old man diagnosed with type 2 esophageal cancer (Lt-Ae, T2N1M0, Stage IIB) who was treated with esophagectomy. Eight months following surgery, solitary adrenal metastasis was detected by CT, and was resected. At 42 months follow-up he has had a good quality of life in the community without evidence of recurrence. To the best of our knowledge, only five cases with resected solitary adrenal metastases including our case, have been reported, and show a greater than 1-year survival. Consequently, we suggest that resection of solitary organ metastases is a good alternative, even following esophagectomy.     

Brain metastasis from stage I esophageal squamous cell carcinoma after surgery: a case report

Esophageal cancer rarely metastasizes to the brain. The authors experienced a case of esophageal carcinoma which metastasized to the cerebellum as the first presentation. A 61-year-old man was identified as having esophageal carcinoma by esophagogastroduodenoscopy during a medical checkup. Subtotal esophagectomy with dissection of 3 regional lymph nodes was performed. The tumor was 30?×?20?mm² in size, and was revealed to be a moderately differentiated squamous cell carcinoma. The pathological finding was T1b(SM)N0M0 stage?I. Fourteen months after the surgery, the patient complained of nausea. Brain magnetic resonance imaging (MRI) showed a cystic tumor of 42?×?28?×?28?mm³ in size in the central cerebellum. No other metastasis was pointed out. A craniotomy for brain tumor resection was performed, and the histopathological examination revealed that it was a metastatic carcinoma from the esophagus. Gamma knife therapy was added. The patient died of cerebellar metastasis recurrence 24?months after the first surgery.     

Salvage esophagectomy through a transhiatal approach for cancer of the thoracic esophagus after left pneumonectomy for lung cancer

Here we report on a 54-year-old man who had undergone left pneumonectomy for a primary lung cancer 25 years earlier and who underwent salvage blunt esophagectomy for a recurrent esophageal cancer after definitive chemoradiotherapy. The patient received chemoradiotherapy for a cancer in the upper thoracic esophagus at the clinical stage IA (T1bN0M0) because of a past history of left pneumonectomy for lung cancer, and the esophageal cancer showed complete response. At 1 year after chemoradiotherapy, local recurrence was found in the upper thoracic esophagus. Although chemotherapy using docetaxel was administered, this was not effective. Transhiatal esophagectomy as salvage surgery was successfully done by a combination of laparo-mediastinoscopy assisted blunt dissection with the eversion stripping method. The postoperative course was uneventful. The patient died of lung and brain metastasis at 23 months after the salvage surgery. Transhiatal esophagectomy may be an option as a salvage esophagectomy in cases with a history of major lung surgery.     

A rare case of advanced esophageal adenocarcinoma with exceedingly long-segment Barrett’s esophagus

A 71-year-old male patient was admitted to our hospital with dysphagia. Upper gastrointestinal endoscopy revealed severe stenosis between 26 and 36 cm from the incisors, and biopsy specimens taken from the stenotic lesion showed well-differentiated adenocarcinoma. A long-segment Barrett’s esophagus (LSBE) between 25 and 40 cm from the incisors was diagnosed. Subtotal esophagectomy with right thoracotomy was performed. Pleural tumor dissemination was seen 7 months later and was treated with chemotherapy. However, the patient died 14 months postoperatively. In Western countries, the incidence of adenocarcinoma in Barrett’s esophagus is high, but in Japan, the incidence is very low. In Japan, the incidence of short-segment Barrett’s esophagus is high, but that of LSBE is very low. We herein report esophageal adenocarcinoma in an exceedingly long LSBE of 15 cm.     

Paraesophageal lymph node metastasis from prostatic adenocarcinoma in a patient with esophageal squamous carcinoma

SUMMARY. Esophageal squamous carcinomas induce regional immune suppression in the domain of the tumor while the global immune system remains intact. We report a patient with a squamous esophageal carcinoma, who was discovered at esophagectomy to have paraesophageal lymph node metastases from a prostatic adenocarcinoma. No other sites of metastatic disease were identified. This supports the concept that regional immune suppression by esophageal squamous cancers facilitates growth of metastases in the local lymph nodes.     

Resection of skeletal muscle metastases from squamous cell carcinoma of the esophagus: case report and literature review

Skeletal muscle metastasis from esophageal squamous cell carcinoma is an unusual entity. A 72-year-old man underwent a subtotal esophagectomy for advanced esophageal squamous cell carcinoma. Mediastinal lymph node metastases developed 36 months after operation, and the patient received chemoradiotherapy. He complained about two painful, subcutaneous masses in the upper part of the left arm at 3 months after the end of chemoradiotherapy. Histopathological examination of tissue specimens obtained by explorative surgery showed skeletal muscle metastases from poorly differentiated squamous cell carcinoma. The patient died of multiple metastases 7 months after chemoradiotherapy. This is considered a very rare case of metastasis from squamous cell carcinoma of the esophagus to the triceps muscle of the left arm.     

Five-year postsurgical monitoring of serum p53 antibody for locally advanced esophageal squamous cell carcinoma

Serum p53 antibody (s-p53-Ab) titers were postoperatively monitored for over 5 years in a 67-year-old man with locally advanced esophageal squamous cell carcinoma. The tumor stage was classified as clinical stage II (cT3N0M0). Serum SCC antigen (s-SCC-Ag; 6.2 ng/mL) and s-p53-Ab (3.83 U/mL) were noted to be positive before surgery. Radical esophagectomy with three-field lymph node dissection was performed without neoadjuvant therapy. Pathological findings of the surgically resected specimens revealed a stage II tumor (pT3N0M0). Postoperatively, the patients did not receive any adjuvant therapy. Although the s-SCC-Ag was found to be negative at 2 months postoperatively, s-SCC-Ag was found to be six times positive despite no signs of recurrence. The s-p53-Ab titers constantly decreased to less than the cutoff value at 6 months postoperatively and continuously decreased over 5 years postoperatively. Finally, s-p53-Ab titers became less than the detection limit value at 60 months postoperatively. No recurrence was observed throughout the postoperative course. This case report is the first to describe the five-year monitoring of postoperative changes in s-p53-Ab titers in a patient with locally advanced esophageal squamous cell carcinoma without recurrence. s-p53-Ab titers seemed to be more useful than s-SCC-Ag for disease monitoring in this case.     

Conversion surgery after S-1 plus oxaliplatin combination chemotherapy for advanced gastric cancer with multiple liver metastases

Conversion therapy for gastric cancer is a new therapeutic concept. We report a case of a patient with advanced gastric cancer who underwent conversion surgery due to a remarkable regression of multiple liver metastases following chemotherapy. A 71-year-old man was referred to our hospital with gastric cancer. Esophagogastroduodenoscopy (EGD) revealed an irregular, nodular, ulcerated lesion in the lower third of the stomach. Analysis of biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography (CT) showed multiple liver mass lesions. The patient was clinically diagnosed with advanced gastric cancer with liver metastases and received S-1 plus oxaliplatin chemotherapy. After 6 cycles of chemotherapy, CT and magnetic resonance imaging showed complete resolution of the liver metastases, and EGD detected mucosal irregularities only. Since there was no evidence of further metastatic lesions in other organs, the patient underwent distal gastrectomy with D2 lymphadenectomy. The gross appearance of the surgically resected specimen showed a slightly elevated tumor measuring 4.5?×?3.5 cm. Pathological examination confirmed the diagnosis of a moderately differentiated gastric adenocarcinoma invading the muscularis propria with no lymph node metastases. The postoperative course was uneventful. The patient has continued to receive S-1 and oxaliplatin chemotherapy, and there has been no evidence of recurrence for 3 months following the operation. We propose that conversion therapy might be an effective treatment for patients with advanced gastric cancer; however, further studies and assessments are needed to confirm and establish this treatment strategy.     

Multiple hematogenous metastasis after curative surgery in a patient with pT1a-LPM pN0 primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus (PMME) is a rare disease. Here, we describe a case of PMME that was identified at a very early stage. A 65-year-old man underwent upper gastrointestinal endoscopy and was found to have a pigmented small nodule in the lower esophagus. A biopsy was taken and diagnosed as malignant melanoma, so the patient then received radical esophagectomy. Histopathological examination showed atypical cell infiltrate in the lamina propria mucosae without lymph-node metastasis. The patient was followed up without adjuvant chemotherapy. Multiple liver and lung metastases were found at 19 months after surgery, and the patient received DAV-feron (DTIC/ACNU/VCR/IFN-β) therapy. However, the tumors progressed and the patient died of the disease at 27 months after surgery. More detailed surveys after surgery with diagnostic imaging and tumor markers are recommended. Adjuvant chemotherapy is worth considering, even in patients with early-stage PMME.     

Isolated breast metastasis from gastric cancer in a male patient

A 72-year-old man underwent total gastrectomy for gastric cancer (por2, T3, N2, Stage IIIA). Eleven courses of postoperative chemotherapy with TS-1 (tegafur/gimeracil/oteracil) were administered. Five months after surgery, the serum carcinoembryonic antigen value was slightly elevated. However, computed tomography did not reveal any metastatic lesions in other organs. Two years after surgery, the patient felt a mass in the left mammary. A 2-cm tumor was palpable in the central portion of the breast. Ultrasonography revealed a hypoechoic tumor, which was Class 3 on aspiration biopsy cytological examination. No mass was detected on positron emission tomography–computed tomography. The mammary gland tumor increased in size to 3 cm, and a core needle biopsy procedure was performed. Histological examination findings revealed breast metastasis of gastric cancer. No other recurrence was found, and radical mastectomy was performed 2 years and 5 months after gastrectomy. Immunohistological analysis of the resected material confirmed breast metastasis of the gastric cancer. Two courses of TS-1 + cisplatin were administered, but this treatment was subsequently terminated because the patient experienced Grade 3 diarrhea and neutropenia. Three years and 1 month after the gastrectomy, the tumor recurred in the pelvic area. Chemotherapy and radiation therapy were performed, but the patient’s overall condition became progressively worse, and he died 3 years and 9 months after gastrectomy.     

A rare case of esophageal cancer (T2N0) with a solitary cerebellar metastasis

A 72-year-old man with a history of distal gastrectomy was diagnosed with esophageal cancer (EC). A subtotal esophagectomy and the residual total gastrectomy were performed via a right-sided thoracotomy and laparotomy with D2 lymph node dissection followed by reconstruction with a retrosternal right colonic interposition. The pathological diagnosis was Mt, 65 mm, moderately differentiated squamous cell carcinoma, pT2, ly0, v2, pN0, sM0, pStage II. The patient suddenly developed neurological symptoms 10 days after the operation, and brain magnetic resonance imaging detected a single solid left cerebellar tumor. This tumor was completely excised, and pathological diagnosis confirmed the tumor as an EC metastasis. He received adjuvant chemotherapy with cisplatin + 5-fluorouracil. Seven months later, he developed multiple brain metastases; however, no evidence of local recurrence or other metastatic sites was found. He died 8 months after the surgery. Solitary cerebellar metastasis from EC in which the primary tumor is T2N0 is rare, and the mechanism of this metastatic pattern is of particular interest. Our case study suggests that even if the primary tumor is in the limited stage and other metastatic sites are not identified at presentation, it seems reasonable to perform preoperative imaging of the brain for all patients with EC.     

Gastric and colonic metastasis from NSCLC: A very unusual case report

Rationale:Lung cancer is the most common cause of cancer-related deaths worldwide. Approximately 50% of patients is metastatic at diagnosis and the most common metastatic sites are bone, lungs, brain, adrenal glands, liver, and extra thoracic lymph nodes. The occurrence of gastrointestinal metastasis from lung carcinoma is rare and seems more commonly related to small cell lung cancer compared to non-small cell lung cancer (NSCLC).Patient information and diagnosis:A 78-year-old man with completely surgically resected NSCLC and no initial evidence of distant metastases developed colon and gastric metastases 7 months after diagnosis, confirmed by serial radiological examinations and endoscopic biopsies.Interventions:The patient was subjected to total gastrectomy with D2 lymph node dissection plus partial colectomy for intraoperative detection of a transverse colon neoformation. Subsequent instrumental imaging showed bilateral lung tumor recurrence, treated with gemcitabine monotherapy for 8 months as first line chemotherapy for lung adenocarcinoma.Results:The patient presented complete response to therapy and was disease-free for 4 years.Lessons:Colonic and gastric metastasis are very infrequent in NSCLC. The resection of gastrointestinal metastasis may provide benefits in terms of both symptom control and survival in patients properly selected.     

Pulmonary metastasectomy for metachronous metastasis of esophageal cancer after esophagectomy

Background and objective

Pulmonary metastasectomy is a standard therapy for some types of metastatic lesions in the lung. Although the prognosis for esophageal cancer patients with pulmonary metastasis is poor, it has been reported that some post-esophagectomy patients have good prognosis after pulmonary metastasectomy. We investigated the role of resecting pulmonary metastases arising from esophageal cancer at our institution.

Patients and methods

Seven patients with primary squamous cell carcinoma or adenocarcinoma of the thoracic esophagus who underwent resection of metachronous pulmonary metastases at our institution between 2006 and 2012 were identified from a retrospective database. All patients had undergone curative resection of their primary esophageal carcinoma.

Results

Six patients had unilateral and solitary lung metastasis. One patient presented with one metastatic lesion on each side, and he underwent 4 metastasectomy for pulmonary metastasis 3 times. There was no perioperative morbidity or mortality. The disease-free interval after esophagectomy ranged from 191 to 559 days (median, 463 days). Survival after pulmonary metastasectomy ranged from 357 to 3191 days (median, 1803 days). Three patients received systemic chemotherapy before metastasectomy. Currently, 5 patients are alive without evidence of recurrent disease.

Conclusion

Pulmonary metastasectomy may be acceptable as a part of multimodal treatment for solitary metachronous pulmonary metastasis in esophageal carcinoma.

     

Long-term survival after resection of brain metastases from esophagogastric junction adenocarcinoma: report of two cases and review of the literature

The prognosis for brain metastasis from primary esophageal or gastric cancer is often poor because of late detection and a lack of effective treatments. We encountered two cases of long-term survival after resection of brain metastasis that was detected >1 year after primary esophagogastric junction adenocarcinoma resection. Both patients underwent total gastrectomy, middle to lower esophagectomy, and Roux-en-Y reconstruction using the jejunum, and intrathoracic anastomosis was performed via right thoracotomy and laparotomy for primary tumor resection as well as brain metastasis resection followed by CyberKnife irradiation. They remained recurrence free—one remains alive after 6.5 years, while the other died of myocardial infarction 4 years after surgery. The present cases emphasize that long-term survival in patients with brain metastasis from gastric cancer can be expected after resection and stereotactic radiosurgery of brain metastasis detected >1 year after the resection of primary gastric adenocarcinoma.     

Case of spontaneous regression of metastatic lesions of leiomyosarcoma of the esophagus

A rare case of spontaneous regression of esophageal leiomyosarcoma is reported. A 63-year-old woman underwent esophagectomy and reconstruction at our hospital after diagnosis of leiomyosarcoma. Nineteen months after esophagectomy, a coin lesion was detected in the right lung and right thoracotomy revealed pleural dissemination. The lesion in the right lung was resected and was confirmed histologically as recurrence of leiomyosarcoma. During further surgery, metastatic lesions were found in the spleen and pleura. However, all metastatic lesions were found to decrease without any anti-cancer therapy.     

Primary adenocarcinoma arising in an interposed colon

We herein report a rare case of adenocarcinoma arising in an interposed colon. A 71-year-old male underwent total thoracic esophagectomy for thoracic esophageal cancer followed by antesternal reconstruction using the right colon. Seven months later, ¹⁸F-fluorodeoxy-glucose positron emission tomography revealed increased uptake in the interposed colon. Endoscopy detected a mass 25 mm in diameter in the cecum of the interposed colon approximately 10 cm from the distal anastomosis. An endoscopic biopsy showed well-differentiated adenocarcinoma. Partial resection of the interposed colon was performed, and the patient’s postoperative course was uneventful. The patient is currently alive with no signs of recurrence three years after the final surgery. We herein report a case of primary adenocarcinoma arising from an interposed colon after esophagectomy and review the literature.     

Pancreatic metastasis of papillary thyroid carcinoma preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report with review of literatures

Pancreatic metastatic tumors from thyroid carcinoma are extremely rare. We report a case of an 80-year-old female with a pancreatic metastatic tumor derived from papillary thyroid carcinoma which was initially resected 158 months prior to detection of the metastatic pancreatic tumor. The patient has encountered cervical lymph-node metastasis on three occasions following the initial operation. Metastatic pancreatic lesions and cervical lymph nodes were first detected using 18-fluorodeoxyglucose positron-emission tomography/computed tomography, and she was preoperatively diagnosed using endoscopic ultrasound-guided fine-needle aspiration biopsy. A coin lesion, 10 mm in size, was detected in the left lung by chest computed tomography with no abnormal uptake in 18-fluorodeoxyglucose positron-emission tomography/computed tomography. Distal pancreatectomy and cervical lymph-node dissection were performed. Adjuvant chemotherapy with weekly paclitaxel was administered because anaplastic transformation had been detected in one of the cervical lymph nodes. The patient eventually died from multiple lung metastases 11 months after removing the metastatic pancreatic lesion. We reported a rare case of a pancreatic metastatic tumor from thyroid carcinoma, and found that 18-fluorodeoxyglucose positron-emission tomography/computed tomography and endoscopic ultrasound-guided fine-needle aspiration biopsy are useful for preoperatively diagnosing tumors.     

Synchronous solitary small intestinal metastasis from esophageal squamous cell carcinoma: report of a case

A 69-year-old male was referred to our hospital with squamous cell carcinoma of the lower thoracic esophagus and a chief complaint of vomiting. On positron emission tomography, fluorodeoxyglucose accumulation was detected in the primary tumor and paraesophageal lymph node. Thoracic esophagectomy and 3-field lymphadenectomy were performed following the administration of neoadjuvant chemotherapy composed of fluorouracil plus cisplatin. Intraoperatively, during the catheter jejunostomy procedure for enteral nutrition, a jejunal nodule measuring 1.5 cm in size at 35 cm distal from the Treitz ligament was detected. The nodule was completely resected using partial jejunotomy. A submucosal tumor-like elevated lesion was seen in the resected specimen. Histologically, squamous cell carcinoma invaded the muscularis propria. Lymphovascular permeation was observed. The patient’s postoperative course was uneventful, and he was discharged on postoperative day 25. After 4 months, CT showed recurrence of multiple liver metastases. Unfortunately, the patient died 6 months after the operation.