Gastric cancer occurring in a patient with Plummer-Vinson syndrome： A case report

Plummer-Vinson syndrome (sideropenic dysphagia) is characterized by dysphagia due to an upper esophageal or hypopharyngeal web in patients with chronic iron deficiency anemia. The main cause of dysphagia is the presence of the web in the cervical esophagus, and abnormal motility of the pharynx or esophagus is also found to play a significant role in this condition. This syndrome is thought to be precancerous because squamous cell carcinoma of hypopharynx, oral cavity or esophagus takes place in 10% of those patients suffering from this malady, but it is even more unusual that Plummer-Vinson syndrome should be accompanied by gastric cancer. We have reported here a case of a 43-year-old woman with Plummer-Vinson syndrome who developed stomach cancer and recovered after a radical total gastrectomy with D2 nodal dissection.     

Endoscopic dilatation and surgical myectomy of symptomatic cervical esophageal webs

During a 10-year period a cervical esophageal web or stricture was diagnosed at rigid endoscopy in 57 patients. Of these patients 72% had restricted their dietary habits because of their symptoms of dysphagia. Cineradiography of the pharynx had revealed abnormalities in 90% of the patients. Dilatation of the webs was performed with semisolid bougies, the endoscope itself, or with balloon inflation. Twelve patients were treated by myectomy of the cricopharyngeal muscle because of unsatisfactory results from the dilatation treatment. Cineradiographic outcome and improvement in dietary habits as a result of the treatment are reported.     

Establishing a prognostic model for metachronous second squamous cell lung cancer in patients with resected squamous cell lung cancer

BackgroundFor metachronous second pulmonary squamous cell carcinoma (msPSC) in patients with resected PSC, the method to distinguish tumour clonality has not yet been well established, which makes it difficult to determine accurate staging and predict prognosis.MethodsPatients who underwent surgery for first PSC and encountered msPSC were recruited from the Surveillance, Epidemiology, and End Results (SEER) database. We extracted overall survival 1 (OS1) for the first PSC, overall survival 2 (OS2) for msPSC, and interval survival for the time interval between the first and second PSC. The nomogram was calibrated for OS2, and recursive partitioning analysis (RPA) was performed for risk stratification.ResultsA total of 617 patients were identified. Several independent prognostic factors were identified and integrated into the nomogram for OS2, including gender, age (2^nd), nodal status (1^st), node metastasis (2^nd), and extrapulmonary metastasis (2^nd). The calibration curves showed optimal agreement between the predictions and actual observations, and the c-index was 0.678. Surgery was associated with longer survival for msPSC patients. The prognosis of sublobectomy was comparable and inferior to that of lobectomy in the low- and moderate-risk groups, respectively. Radiotherapy was associated with better outcomes in patients who did not undergo surgery.ConclusionsThe RPA-based clinical nomogram appears to be suitable for the prognostic prediction and risk stratification of OS2 in msPSC. This practical system may help clinicians make decisions and design clinical studies.     

CASE REPORT: Primary cystic keratinizing squamous cell carcinoma of the liver in a patient with treated nasopharyngeal carcinoma

Primary squamous cell carcinoma of the liver is very rare; only 18 cases have been recorded. In the present report we document an additional case who had a unique history of stage III non-keratinizing nasopharyngeal carcinoma treated with a full course of radiotherapy in July 1993. Two small hypoechoic cyst-like lesions in the left hepatic lobe were identified at the same time. In July 1995 the 50-year-old patient reported to be suffering from abdominal fullness and tenderness. A large hypodense tumour was demonstrated in the left hepatic lobe by abdominal echography. The patient was diagnosed as having metastatic carcinoma and received two courses of pre-operative chemotherapy followed by left lobectomy of the liver and resection of adherent tissues on 9 August 1995. Pathological study demonstrated a large hepatic cystic keratinizing squamous cell carcinoma, which most likely arose from a solitary hepatic cyst. Tumour seedings, probably secondary to tumour rupture, were also revealed on the omentum, peritoneum and diaphragm. However, regional lymph nodes were free of tumour. Systemic work-up failed to demonstrate evidence of local recurrence of nasopharyngeal carcinoma, metastatic lesion or any second primary tumour site.     

Basaloid squamous carcinoma of esophagus:a clinicopathological, immunohistochemical and electron microscopic study of sixteen cases

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Endoscopic diagnosis and treatment of esophageal verrucous squamous cell cancer

Verrucous squamous cell cancer (VSCC) of the esophagus is a variant of squamous cell carcinoma. This rare entity has been described in only a handful of case reports in the literature. We sought to evaluate the endoscopic features, treatment, and outcomes related to esophageal VSCC. The medical records of all patients with esophageal VSCC seen at our institution from January 1995 to December 2010 were reviewed retrospectively. A total of 11 patients (6 men; mean age 66 years [range 57–75 years]) were identified, with a mean follow up of 4 years (range 0.5–10 years) available in nine patients after diagnosis. About half the patients smoked or consumed alcohol on a regular basis. The median time interval from onset of symptoms to diagnosis of esophageal VSCC was 2.5 years (range 1–20 years), with dysphagia being present in all patients. The majority of tumors (8 of 11) exhibited a white, warty, plaque‐like appearance with superimposed Candida at endoscopy, which led solely to a diagnosis of Candida esophagitis on initial presentation. The disease was either extensive (n = 5) throughout the esophagus or localized (n = 6) often by tumor nodules or projections, with the lower third of the esophagus being most commonly involved. Initial pinch biopsies were nondiagnostic in eight (73%) of the patients. Six patients underwent esophagectomy; neoadjuvant chemoradiation therapy was provided in two. In patients treated solely with surgery and who had a preoperative endoscopic ultrasound, the latter tended to overestimate staging of the lesion relative to surgical pathologic staging. Two patients were deemed to be poor operative candidates and received only chemoradiation treatment. One patient with a T2N0 tumor by endoscopic ultrasound staging was managed symptomatically with intermittent endoscopic dilation because of significant comorbidities that precluded surgery and oncologic therapy. There has been no evidence for residual or recurrent neoplastic disease in the eight patients who received treatment with surgery and/or chemoradiation therapy. Five of six patients who underwent surgery have required intermittent endoscopic dilation of anastomotic strictures during follow up. One of the two patients who received only chemoradiation therapy has required periodic endoscopic dilation for radiation‐induced esophageal stricture. Two of the nine (22%) patients have died of causes unrelated to VSCC or its treatment at last follow up. In conclusion, a high index of suspicion for esophageal VSCC should be raised by the presence of long‐standing symptoms coupled with white, warty esophageal lesions seen on endoscopic evaluation. Candida overgrowth can be expected to confound the diagnosis. Despite the long duration of symptoms, surgical resection typically shows relatively low‐grade tumors, consistent with the rare propensity of this variant of esophageal squamous cell carcinoma to metastasize.     

Treatment Strategy after Endoscopic Resection of Superficial Esophageal Squamous Cell Carcinoma: A Single Institution Experience

Background/Aims

The aim of this study was to analyze and propose a treatment strategy after endoscopic resection of superficial esophageal squamous cell carcinoma in a single institution.

Methods

This is a retrospective review of 37 patients who were treated by endoscopic resection during a 6-year period.

Results

The mean tumor size was 11.5±5.5 mm (range, 3 to 31 mm). Thirty-one lesions (83.8%) were treated by endoscopic submucosal dissection, and six lesions were treated by endoscopic mucosal resection (16.2%). The en bloc resection rate and complete resection rate were 91.9% and 81.8%, respectively. The tumor invasion depth was diagnosed as epithelial in five cases (13.5%), lamina propria mucosa in 12 cases (32.4%), muscularis mucosa in 10 cases (27.0%) and submucosa in 10 cases (27.0%). The complication rate was 13.5% and included three cases (8.1%) of perforation. Ten patients who had muscularis mucosa and submucosa lesions received additional treatments, including six patients who were treated with esophagectomy, three patients who were treated with radiotherapy and one patient who was treated with chemoradiotherapy. One patient with lamina propria lesions received radiotherapy due to a positive resection margin. The median follow-up duration was 22 months (range, 4 to 79 months), and no recurrence or metastasis was noted during follow-up.

Conclusions

Tailored management after endoscopic treatment of superficial esophageal squamous cell carcinoma can offer an acceptable oncologic outcome in early esophageal carcinoma.     

Combined treatment of squamous cell carcinoma of the anal canal: Radical radiation therapy with 5-fluorouracil and mitomycin-C,a preliminary report

Radical radiation therapy combined with 5-fluorouracil and mitomycin-C was studied in six patients with previously untreated operable squamous cell carcinoma of the anal canal. All six patients achieved local tumor control and have retained anal continence. There has been no evidence of late recurrence to date. This preliminary report demonstrates that this method of treatment warrants further study.