Synchronous carcinoma of the esophagus and the thyroid gland

INTRODUCTION: Incidence of synchronous or metachronous carcinomas with primer esophageal malignancy together can be estimated at 17% and these disorders manifest mostly in the stomach. CASE REPORT: The authors report the medical history of a 55-year-old man whose symptomatic middle third esophageal carcinoma was cured with esophagectomy and two field lymphadenectomy. Stomach was used for substitution. Histological examination verified pT2N1M0 tumor and metastasis of papillary thyroid carcinoma from the lymph node removed from near to the right recurrent nerve. Five weeks after the esophageal resection a total thyroidectomy and a central lymph node dissection was performed. The synchronous thyroid carcinoma was located into the inferior pole of right lobe. Currently the patient is without symptoms and plaints, the complex oncological treatment is in progress. DISCUSSION: The incidence of a synchronous carcinoma of the esophagus and the thyroid gland is an extreme rarity. The basic difference connected to the tumorbiological behaviors of these two malignancies is found in the growing tendency and in the direction of lymphogen spreading. The common point is the recurrent nerve lymphatic chains in the thoracic dome. This is the reason that after the R0 resection of a middle third esophageal carcinoma the histological evaluation of a lymph node obtained from right recurrent nerve lymphatic chain shed light on the asymptomatic synchronous thyroid cancer. CONCLUSION: In cases of operable esophageal carcinomas located into its middle or lower third the importance of a correct lymphadenectomy could not be emphasize enough. During the routine preoperative examinations it would be necessary to make cervical ultrasonography too.     

Focal fatty change in the medial segment of the liver occurring after gastrectomy: report of a case

A 70-year-old Japanese man underwent distal gastrectomy for gastric cancer. Preoperative computed tomography detected no tumor in the liver. Six months after the operation, ultrasound examination revealed a hyperechoic mass, measuring 3 cm in diameter, in the medial segment of the liver. Dynamic computed tomography of the liver also revealed that low-density area with mosaic enhancement in the dorsal portion of the medial segment. Assay for hepatitis B surface antigen was positive. Levels of carcinoembryonic antigen and alpha-fetoprotein were normal. Computed tomography during arterial portography revealed a perfusion defect in the area corresponding to the mass lesion. Although laparotomy was performed, no abnormality was found in the dorsal portion of the medial segment on inspection and palpation during surgery. We therefore performed incisional biopsy and frozen histologic examination, which revealed fatty deposition in the hepatic parenchyma and no evidence of malignancy. Finally, histologic examination made a diagnosis of macrovesicular steatosis surrounded by normal liver parenchyma.     

Concurrent occurrence of a gastric cancer with a hepatocellular carcinoma: report of a case: incidental or causal association?

Little information regarding synchronous gastric cancer associated with hepatocellular carcinoma is available and has been sporadically reported. We report a new case of 60 years old patient operated for gastric carcinoma. The radiological investigations revealed a hepatic nodule which correspond to a hepatocellular carcinoma on histological examination. The aim of this study is to clarify the clinicopathologic and therapeutic features of this association.     

管状胃在食管癌手术中的应用

目的探讨管状胃在食管癌切除术中的临床应用。方法对96例食管癌切除用管状胃重建上消化道患者资料进行回顾性分析,并重点探讨管状胃的制作方法及该术式在防止并发症方面的优势。结果本组1例死亡,95例术后均顺利康复出院。85％得到随访,随访时间6～18个月不等,无吻合口瘘、胸胃综合征及明显反流性食管炎等并发症发生。结论管状胃在食管癌手术中并发症发生率低,可改善患者的生活质量,具有较好的临床应用价值。     

东台市2009—2011年60岁以上居民恶性肿瘤死因调查分析

目的了解东台市60岁以上居民恶性肿瘤死因及其寿命损失情况,为老年人恶性肿瘤防治提供科学依据。方法应用死亡率、潜在寿命损失年和平均减寿年数等指标对2009—2011年东台市60岁以上居民恶性肿瘤死因进行汇总分析。结果 （1）2009—2011年60岁以上居民恶性肿瘤年均标化死亡率为940.34/10万,前4位死因分别是食管癌、胃癌、肺癌和肝癌;（2）食管癌、胃癌、肺癌和肝癌男性死亡率明显高于女性;65~84岁组食管癌、胃癌和肺癌持续上升,85岁以后食管癌、胃癌趋于稳定,肺癌逐渐下降;（3）食管癌、胃癌、肝癌、脑癌和骨癌农村死亡率明显高于城镇;食管癌、肺癌、肝癌和女性生殖器癌堤东死亡率高于堤西,尤以肝癌为甚;（4）YPLL标化率为77.41‰,AYLL为8.89年,YPLL标化率较高的有食管癌、胃癌、肺癌和肝癌。结论恶性肿瘤是我市60岁以上居民的主要死因之一,主要是上消化道肿瘤、肺癌和肝癌。食用腌制食品、环境污染和家族史可能是诱发因素。倡导健康的生活方式可以降低老年人恶性肿瘤死亡率。     

13637例新发恶性肿瘤患者资料分析与干预

目的了解汕头市区恶性肿瘤疾病构成特点,为掌握肿瘤流行病学特点提供参考。方法分析汕头大学医学院第一附属医院和第二附属医院2003—2007年13637例新发恶性肿瘤住院患者的疾病顺住和性别年龄分布。结果胃食管癌和肺癌在恶性肿瘤构成中仍然居前列,其中男性前三位恶性肿瘤为：胃癌、肺癌、食管癌;女性前三位为：乳腺癌、胃癌、肺癌。男女比例为6：4。恶性肿瘤确诊年龄（54．83±16．59）岁,男性平均年龄为（57．00±16．32）岁,女性平均年龄为（51．52±16．44）岁。结论汕头市恶性肿瘤发病年龄呈年轻化趋势。胃食管癌、肺癌仍是汕头市恶性肿瘤防治重点。     

X-ray examination of the gastrointestinal tract in systemic cutaneous disease]

An X-ray examination of the gastrointestinal tract was performed on 56 patients with systemic cutaneous disease that is often considered associated with internal malignancies. Found were one case of esophageal cancer, two cases of gastric cancer, and two cases of colon cancer. The prevalence of gastric and colon cancer in these patients showed a statistically significant increase compared to the general population. The rate of gastric cancer was 16.26 times higher than the general population and that of colon cancer 32.26. X-ray examination of the gastrointestinal tract in patients with systemic cutaneous disease is useful for detecting malignancy.     

Papillary thyroid carcinoma associated with parathyroid adenoma

Concomitant papillary thyroid cancer and parathyroid adenoma is rare. We report a 55 years old female with papillary cancer admitted for surgery. Preoperative laboratory findings revealed hypercalcemia and then primary hyperparathyroidism. Thyroidectomy, neck dissection and excision of parathyroid adenoma were performed. Histological examination revealed parathyroid adenoma. Serum calcium returned to normal range after surgery. We recommend preoperative check of calcium in patients with thyroid cancer.     

Free jejunal intrathoracic graft after esophageal replacement failure

We present the case of a 24 year old man who suffered from severe chronic esophagitis and an esophageal stricture. He was managed by gastric pull-up but complicated by leakage of the anastomosis. Subsequent sophageasurgical treatment with free jejunal graft was performed and the rationale for the technique selected is discussed.     

Huge myxoid liposarcoma of the esophagus: a case report

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare.     

上消化道恶性肿瘤饮食危险因素的病例对照研究

目的　探讨饮食因素的致病作用。方法　对209例上消化道肿瘤进行1∶1配对病例对照调查,其中食管癌68对,贲门癌69对,其他部位胃癌72对。结果　结果表明,吃腌菜是重要的危险因素(分别OR=2.82、5.17、2.92),对3种部位肿瘤均起作用;剩饭菜是食管癌和贲门癌的危险因素(OR=1.88和OR=1.90);喜咸是贲门癌的危险因素(OR=1.87);绿茶是食管癌和除贲门外胃癌的保护因素(OR=0.20和OR=0.28);水果是食管癌的保护性因素(OR=0.51)。结论上消化道癌与饮食因素有关,但其重要性可因肿瘤部位、暴露剂量、地区等不同而变化。     

Prognosis was not deteriorated by multiple primary cancers in esophageal cancer patients treated by radiotherapy

Esophageal cancer patients are often associated with multiple primary cancers (MPC). The aim of this study is to evaluate the effect of MPC on prognosis in esophageal cancer patients treated by radiotherapy. Between 2001 and 2008, esophageal cancer patients treated by definitive radiotherapy at Gunma Cancer Center were retrospectively reviewed. Exclusion criteria were preoperative or postoperative radiotherapy, palliative radiotherapy, follow-up of <6 months, radiation dose of <50 Gy and no information on MPC. We analyzed 167 esophageal cancer patients and 56 (33.5%) were associated with MPC. Gastric cancer was the most frequent tumor (38.2%), followed by head and neck cancer (26.5%). Median follow-up time was 31.5 months (range 6.1–87.3 months). Patients with MPC included more stage I/II esophageal cancer than those without MPC (66.1% vs. 36.9%, P < 0.01). The 5-year overall survival rate for esophageal cancer with MPC was relatively better than those without MPC (46.1% vs. 26.7%), although the difference did not reach statistical significance in univariate analysis (P = 0.09). Stage I/II esophageal cancer patients had a significantly better overall survival than stage III/IV patients (P < 0.01). Among esophageal cancer patients with MPC, there was no difference in overall survival between antecedent and synchronous cancer (P = 0.59). Our study indicated that the prognosis of esophageal cancer patients treated by radiotherapy was primarily determined by the clinical stage itself, but not the presence of MPC.     

Esophageal squamous cell carcinoma with pancreatic metastasis: a case report

Malignant tumors of pancreas are usually primary neoplasms and pancreatic metastases are rare findings. We are reporting a case of squamous cell carcinoma (SCC) of the esophagus with pancreatic metastasis. A 59-year old woman was admitted with chief complaint of abdominal pain and mass. She was a known case of esophageal SCC since 4 years before when she had undergone transthoracic esophagectomy and cervical esophago-gastrostomy. In order to evaluate recent abdominal mass, CT scan was done which revealed septated cystic lesion in the body and the tail of the pancreas. Palliative resection of the tumor was performed and its histological study showed SCC compatible with her previously diagnosed esophageal cancer.     

HES1与ICN1、Notch1在胃癌组织中的表达及其意义

目的:探讨Notch1信号通路主要分子在人胃癌组织中的表达及意义。方法:免疫组化SP法观察HES1、ICN1、Notch1在胃癌组织、癌旁萎缩性胃炎、癌旁浅表性胃炎、胃镜浅表性胃炎中的表达,分析三者表达与胃癌临床病理特征的关系以及胃癌组织中三者表达的相关性。结果:(1)HES1在胃癌组织的表达高于癌旁浅表性胃炎和胃镜浅表性胃炎(P<0.05);HES1表达与胃癌浸润深度、淋巴转移和肿瘤分期相关(P<0.01)。(2)Notch1、ICN1在胃癌组织的表达低于癌旁萎缩性胃炎(P<0.001);Notch1、ICN1的表达与胃癌分化程度相关(P<0.05)。(3)胃癌组织中Notch1、ICN1的表达呈正相关(P<0.01),HES1与Notch1、ICN1的表达无显著相关性。结论:HES1促进胃癌的发生发展并可能主要由其他通路调控;Notch1与胃癌的分化有关。     

7 439例肿瘤患者临床流行病学分析

目的研究恶性肿瘤病例,为恶性肿瘤防治提供依据。方法回顾性调查相关病历,并对相关数据进行统计分析。结果肺癌构成比最高,其次是胃癌和食管癌。男性前3位是肺癌、胃癌和食道癌,女性前3位是肺癌、胃癌和乳腺癌。结论恶性肿瘤构成比男性多于女性,肺癌构成比最高。     

Diagnostics and clinical significance of esophageal metastasis of adenocarcinoma of the gastroesophageal junction

PATIENT AND METHODS: 174 patients who had cardiac adenocarcinoma were examined in the endoscopic laboratory of the Surgical Department between March 1, 1994 and October 29, 2002. In the course of the endoscopic examinations intramural metastases were found in 19 patients (10.9%). Of the patients with esophageal metastasis, five had type 1 tumor, 10 had type 2 tumor, and 4 had type 3 tumor of the Siewert-Stein categorization. 16 of the patients were male, 3 were female. Seven patients had only one metastasis in the oesophagus, in the other patients the number of metastases varied between 2-5. Surgical intervention: in 4 out of the 19 patients no surgical intervention was performed, because they had extended metastases. In 4 patients a tube was inserted surgically, 1 patient had gastrostomy, 1 patient had explorative laparotomy, and another patient had diagnostical laparoscopy. Eight patients had gastric and esophageal resection/gastrectomy for palliative reason. RESULTS: Survival data of six patients out of the 19 were not evaluated, because in 1 case there was a postoperative complication, and in five patients the time passed since the diagnosis was too short. Mean survival time: 1/ patients with tube insertion: 128.25 days; 2/ no-intervention cases: 248 days; 3/ after the gastrectomy: 164 days; 4/ after the explorative laparotomy: 180 days; 5/ after diagnostic laparoscopy: 108 days. 6/ after gastric and esophageal resection/gastrectomy: 474 days (211 days the shortest, 723 days the longest). In case of those patients, who underwent resection, the survival was longer and the quality of life was better than in the other groups. CONCLUSIONS: 1. The intramural esophageal metastases of the cardiac adenocarcinomas are detectable by a routine endoscopic examination and confirmed by histological investigation. 2. Esophageal metastases of cardiac adenocarcinomas occur in all the three types of the Siewert-Stein classification. 3. The metastasis on the oesophagus means a developed stage of the tumor. 4. The proper therapy--although it can only be palliative--will increase the survival time of acceptable quality for the patient. 5. There was no significant difference in the survival time of patients after the removal of different types of Siewert-Stein tumors.     

Less mutilating treatment of penile carcinoma

Four patients with penile carcinoma are described. A 60-year-old man with a T1-tumour underwent penis-conserving laser treatment. Two men, aged 52 and 65 years old, with T2-tumors and clinically node-negative groins underwent penile amputation. Sentinel-node biopsy (SNB) revealed no metastases in the 52-year-old patient. High-resolution ultrasound-guided fine-needle aspiration cytology revealed bilateral metastases in the other patient, who underwent bilateral inguinal lymphadenectomy. In the fourth patient, a 73-year-old man with a T3-tumor, a pathological lymph node was palpated in one groin. Inguinal lymphadenectomy revealed 3 positive nodes and an additional pelvic lymphadenectomy was performed. SNB on the other side was positive and inguinal lymphadenectomy followed. No additional positive nodes were found in the dissection specimen. All patients were alive without evidence of disease 4, 3, 3 and 4 years later, respectively. New developments in the management of penile cancer such as laser treatment, high-resolution ultrasonography and SNB result in a more tailored approach with less morbidity without reducing survival rates.     

食管癌术后并发胃排空障碍30例分析

目的探讨食管癌根治术后胃排空障碍(胃瘫)的高危因素和治疗。方法将食管癌根治术后并发胃瘫的30例患者设为胃瘫组,与同期随机选取的食管癌术后未发生胃瘫的60例患者进行比较,对上述临床资料进行回顾性分析。结果高龄、术前伴有糖尿病、颈部吻合和术时>3h是并发胃瘫的高危因素(P0.05)。结论高龄、术前伴有糖尿病、颈部吻合和手术时间长是食管癌术后发生胃瘫的高危因素。对于机械性胃瘫需及时手术治疗,而功能性胃瘫经非手术治疗均可治愈。     

2015年四川省胃癌和食管癌发病及死亡分析

目的分析2015年四川省上消化道恶性肿瘤(胃癌和食管癌)发病、死亡和潜在减寿情况。方法收集四川省24个肿瘤登记处上报的2015年恶性肿瘤发病、死亡及人口资料。提取ICD-10编码C15-C16选择食管癌、胃癌的发病和死亡数据,用SAS 9.3软件分别计算性别、年龄别发病和死亡的粗率、标化率、构成比、累积率(0~74岁)、潜在减寿年数(potential years of life lost,PYLL)、潜在减寿率(potential years of life lost rate,PYLLR)和平均减寿年(average years of life lost,AYLL)。标准人口采用2000年全国普查人口年龄构成和Segi’s世界人口年龄构成。结果2015年四川省肿瘤登记地区食管癌和胃癌发病率分别为29.29/10万和28.60/10万,分别居发病第3位和第4位;胃癌和食管癌死亡率分别为23.90/10万和22.20/10万,分别居死亡第3位和第4位;根据上消化道恶性肿瘤发病率和死亡率的年龄性别分布,男女性45岁后发病率和50岁后死亡率均显著升高;无论城乡,男性食管癌和胃癌各项发病和死亡指标均高于女性。农村地区人群食管癌和胃癌疾病负担高于城市。食管癌潜在减寿年数为23399人年,平均减寿年数为15.41年,减寿率为1.92‰;胃癌潜在减寿年数为25390人年,平均减寿年数为16.74年,减寿率为2.09‰。结论四川省食管癌和胃癌发病与死亡水平相对较高,男性为食管癌和胃癌的高发人群,45岁以上的中老人群是上消化道恶性肿瘤高风险人群,农村地区人群的上消化道肿瘤疾病负担高于城市。     

胃窦癌前哨淋巴结及淋巴结转移规律的临床研究

目的研究胃窦癌前哨淋巴结分布规律并探讨其在早期胃窦癌手术治疗中的临床应用价值。方法在对病人行胃癌手术前先进行前哨淋巴结活检(即开腹后在原发灶周围注射亚甲蓝,切除在5min之内被染色的所有淋巴结),然后行胃切除手术和扩大淋巴结切除术。结果本组病人30例有29例均找到SLN(成功率为99%),均为幽门下淋巴结(第六组淋巴结),并对淋巴结转移规律进行研究,为胃窦癌手术淋巴结清扫范围提供参考依据。结论对于SLN阴性及早期胃窦癌施行D1或D1+切除可获得A级根治度,并通过亚甲蓝术中间接淋巴染色,可提高胃癌根治术中淋巴结和阳性淋巴结清除的绝对数,避免不必要的标准手术,减少并发症。