A case of esophageal squamous cell carcinoma with positive HPV 11

HPV (human pappiloma virus) infection is an etiologic risk factor for esophageal carcinoma with several studies supporting its carcinogenic role. The main strains are HPV16 and 18 and the less frequent strains 11, 6, 31 and 36. We report the case of a 58 year old male, smoker, admitted to our hospital for progressive dysphagia. Previous endoscopies and biopsies were compatible with a hyperkeratotic esophagus, negative for dysplasia. Second endoscopy showed a hyperkeratotic, verrucous, esophagus with two circumferential stenosis which were dilated with TTS (Through the Scope) balloon. Biopsies revealed multiple squamous cell abnormalities, negative for dysplasia and positive for HPV 11. Symptoms recurred, and he was submitted to another upper gastrointestinal endoscopy with dilation of the stenosis and esophageal stent placement. Two months later, esophagectomy was performed, and the histopathological analysis revealed a squamous cell carcinoma of the esophagus (T2, N0, M0, G1). The patient died after surgery due to acute respiratory distress syndrome.     

Severe benign esophageal stricture following postoperative emesis

An 80-year-old man presented with dysphagia after surgery for a hepatic tumor. In the postoperative period, he suffered from emesis and thereafter experienced dysphagia when taking a solid meal. The cause of his dysphagia was a benign lower esophageal stricture that had not been detected during preoperative examinations. Conservative treatment involving balloon dilatation was not effective, and the patient finally underwent a lower esophagectomy with reconstruction of the jejunum interposition from a left thoraco-abdominal approach. Based on his clinical manifestations, pathological findings, and published reports, we suggested that he suffered an incomplete esophageal perforation after emesis that led to esophageal stricture as a result of fibrosis of the esophageal wall. This rare case demonstrates that an esophageal injury caused by postoperative emesis can result in a benign esophageal stricture.     

A case of congenital esophageal stenosis that remained untreated until adulthood and was improved by endoscopic balloon dilatation

A 20-year-old man had suffered from dysphagia since primary school. Upper gastrointestinal and endoscopy examinations revealed severe circumferential stenosis of the upper intra-thoracic esophagus. Secondary stenosis due to factors such as inflammation did not appear present, so congenital esophageal stenosis (CES) was diagnosed. Dysphagia improved after two endoscopic balloon dilatations. Almost all cases of CES are treated in baby-hood, and individuals who remain untreated until adulthood are rare. Check ups and diagnoses should be made taking CES into consideration, even in adults.     

Esophageal squamous cell carcinoma with dural and bone marrow metastases

Patients with esophageal squamous cell carcinoma generally present at an advanced stage at the time of diagnosis. The most common sites of visceral metastasis are the lung, liver and bone, but brain and bone marrow involvement is exceedingly rare. Herein, we report a 62-year-old man with a 4-wk history of progressive low back pain with radiation to bilateral lower legs, dysphagia and body weight loss. Esophageal squamous cell carcinoma with regional lymph node, liver and bone metastases was diagnosed. He underwent concurrent chemoradiotherapy and got a partial response. Four months later, he complained of headache, diplopia and severe hearing impairment in the left ear. There was no evidence for bacterial, fungal, tuberculous infection or neoplastic infiltration. Magnetic resonance imaging of the brain demonstrated thickening and enhancement of bilateral pachymeninges and multiple enhancing masses in bilateral skull. Dural metastasis was diagnosed and he received whole brain irradiation. In addition, laboratory examination revealed severe thrombocytopenia and leucopenia, and bone marrow study confirmed the diagnosis of metastatic squamous cell carcinoma. This is the first described case of esophageal squamous cell carcinoma with dural and bone marrow metastases. We also discuss the pathogenesis of unusual metastatic diseases and differential diagnosis of pachymeningeal thickening.     

Pulmonary tumor thrombotic microangiopathy associated with esophageal squamous cell carcinoma

Pulmonary tumor thrombotic microangiopathy (PTTM) is an uncommon cancer-related complication that has been most frequently reported to be associated with adenocarcinoma. We present a case of PTTM which developed in a 60-year-old man with esophageal carcinoma. One year after definitive treatment of the tumor, he developed pulmonary hypertension. Transbronchial lung biopsy (TBLB) specimens showed fibrocellular intimal proliferation and luminal stenosis of the small pulmonary vessels, which contained squamous cell carcinoma cells. Thus, PTTM associated with esophageal carcinoma was diagnosed. This is the first reported case of PTTM associated with esophageal squamous cell carcinoma. TBLB seemed to be useful for obtaining a definitive diagnosis.     

Esophageal squamous cell carcinoma co-existing with achalasia: report of two cases

Esophageal achalasia is a primary motility disorder of the esophagus. Although various treatments can relieve the symptoms, esophageal cancer arising in patients with achalasia is the most important problem for long-term survivors. We encountered 2 cases of esophageal squamous cell carcinoma co-existing with achalasia that had been diagnosed 27 and 30 years earlier, respectively. Neither patient had been aware of dysphagia due to dilatation of the esophagus. Both patients underwent esophagectomy via right thoracotomy. Although esophagectomy with radical lymphadenectomy was performed successfully in one case of submucosal cancer, the primary tumor in the other case was more invasive and aggressive than indicated by the preoperative clinical diagnosis, and could not be completely resected. Regular endoscopic examination should be scheduled for long-term survivors of achalasia in order to detect esophageal cancer early and evaluate any changes in the esophagus carefully.     

Development of Squamous Cell Carcinoma of the Esophagus after Endoscopic Variceal Sclerotherapy

We describe the case of a 45-yr-old white male with portal hypertension and presumed Laennec's cirrhosis who developed squamous cell carcinoma of the esophagus 8 months after completion of a course of endoscopic variceal sclerotherapy. The epidemiology and natural history of esophageal cancer and their relationship to our patient are analyzed. This report emphasizes that squamous cell carcinoma of the esophagus should be considered in the differential diagnosis of postsclerotherapy dysphagia. Further studies will be required to determine whether or not esophageal variceal sclerotherapy is associated coincidently or causally with the development of squamous cell carcinoma of the esophagus in patients at increased risk for this condition.     

An unusual case of upper GI bleeding: esophageal cancer metastasis at a percutaneous endoscopic gastrostomy site--case report and review of the literature

We present the case of a patient with an esophageal squamous cell carcinoma, who was treated primarily by radiotherapy. Due to dysphagia, the patient received a percutaneous endoscopic gastrostomy (PEG) without any sign of tumour at that time. Five months later the patient presented with an upper GI bleeding from a gastric ulcer, which histologically turned out to be a metastasis of the previously diagnosed squamous cell carcinoma. So-called "implantation metastases" at the percutaneous endoscopic gastrostomy site are rare and most of the cases have been described in patients with head and neck tumours. Moreover, the presentation as an upper GI bleed is very uncommon and needs the attention of both endoscopists as well as gastrointestinal oncologists. Clinicopathological features of this case with a brief review of the literature are presented.     

Esophageal papillomatosis complicated by squamous cell carcinoma

Esophageal papillomatosis is a very rare condition that is believed to have a benign clinical course. Recent reports underscore the potential development of a malignancy in association with squamous papillomatosis of the esophagus. A case of esophageal papillomatosis complicated by the development of esophageal invasive squamous cell carcinoma diagnosed after esophagectomy, despite multiple nondiagnostic endoscopic biopsies, is described. The patient also developed squamous cell carcinoma in the oral cavity and pyloric channel. The finding of extensive esophageal papillomatosis and unremitting dysphagia symptoms should prompt investigations into an underlying associated malignancy.     

Triple secondary malignancy of gingiva, palate and esophagus after an allogeneic bone marrow transplantation for cutaneous T-cell lymphoma

A 31-year-old man was diagnosed as having cutaneous T-cell lymphoma in January 1994. He received an allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling donor in May 1995, because of refractoriness to chemotherapy. The patient had been treated with immunosuppressants including prednisolone and cyclosporin A for chronic graft-versus-host disease (GVHD) of the extensive type following acute GVHD. Five years after the BMT, he developed moderately differentiated squamous cell carcinoma (SCC) on the mandibular gingival mucosa and underwent surgical resection. Furthermore, 6 years after the BMT well differentiated SCC developed on his palate and was resected. Concurrently, he was diagnosed as having esophageal cancer (poorly differentiated SCC) and underwent a subtotal esophagotomy. One year later he had a recurrence of the esophageal cancer with dysphagia and was treated with radiation and chemotherapy. He remains free of triple cancer and lymphoma. It is suggested that total body irradiation, immunosuppressants, and chronic GVHD are associated with a risk of secondary malignancies following allogeneic BMT. These factors might have contributed to the onset of triple cancer in our patient.     

Endotracheal metastasis from basaloid squamous carcinoma of the esophagus

Endobronchial metastases from extrapulmonary neoplasms are rare events, and there is no report in the literature of metastasis originating from esophageal cancer. Basaloid squamous carcinoma of the esophagus is a rare histologic type that is known to be a biologically aggressive phenotype. We describe a rare case of metachronous endotracheal metastasis originating from esophageal basaloid squamous carcinoma. A 72-year-old Japanese man underwent esophagectomy for stage I esophageal cancer. Pathological diagnosis of the resected specimen was basaloid squamous carcinoma. One year later, a follow-up computed tomography scan displayed a tumor shadow in the tracheal wall. Bronchoscopy revealed a protruding tumor in the tracheal wall, and the pathologic diagnosis of the biopsy specimen was also basaloid squamous carcinoma. According to the diagnosis of metachronous endobronchial metastasis from esophageal basaloid squamous carcinoma, we treated the patient with chemotherapy comprising docetaxel, cisplatin, and 5-fluorouracil followed by chemoradiotherapy, and complete response was achieved. The patient has not suffered a recurrence of the disease for 23 months since the diagnosis of the endobronchial tumor. Careful follow-up is needed to ensure that rare types of metastasis are not missed in cases with biologically aggressive tumors.     

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.     

Successful treatment for a patient with esophageal carcinoma that amalgamates with polymyositis: a case report

Polymyositis is known to amalgamate with malignant tumor. Here, we report a case of successfully resected esophageal carcinoma that amalgamated with polymyositis. Moreover, this is a rare case of squamous cell carcinoma combined with Barrett’s adenocarcinoma. A 47-year-old man was admitted to a hospital because of progressive dysphagia and difficulty in walking. Laboratory data showed creatine phosphokinase (CPK) was elevated, and he was diagnosed with polymyositis. He was treated with steroids, and the symptoms were improved with decreased CPK. Endoscopic and pathological examination showed a squamous cell carcinoma (0-Ipl, SM2-3) combined with Barrett’s adenocarcinoma (0-IIa, M2) of the esophagus. Although we were concerned about postoperative complications associated with polymyositis, the postoperative course was good, with decreased steroid, and he was discharged on the 21st postoperative day. At 1.5 years after surgery, he reports no recurrence of polymyositis or esophageal cancer.     

Outcomes from chemoradiotherapy for patients with esophageal cancer

Chemoradiotherapy is a widely used alternative treatment to surgical resection in certain patient groups with early esophageal cancer. The aim of this study was to retrospectively assess toxicity and outcome of patients treated with definitive chemoradiotherapy for early esophageal cancer at one institution. A retrospective analysis of all patients treated with chemoradiotherapy between February 2000 and December 2008 at a single tertiary center was performed with documentation of treatment given, toxicities recorded, and follow‐up and outcome data. Sixty‐two patients received chemoradiotherapy for esophageal cancer. There were 20 males and 42 female patients with an average age of 68 years. Histology revealed adenocarcinoma in 28 patients and squamous cell carcinoma in 34 patients. All patients were staged with a computerized tomography scan, endoscopic ultrasound and positron emission tomography scan. Selection criteria for chemoradiotherapy were unfit for surgery, upper esophageal squamous carcinoma, unresectable primary tumor, or patient choice. The majority of the patients received a combination of cisplatin and 5‐fluorouracil chemotherapy with 55 Gy in 25 fractions of radiotherapy. Grade 3 toxicities were recorded in 11% of the patients. Eleven patients suffered from local recurrence and a stent was required in nine patients. Radiation strictures occurred in 10 patients requiring dilation in four. Five patients required a radiologically inserted feeding gastrostomy. The median overall survival was 21 months. Patients with adenocarcinomas and those with squamous cell carcinoma had a similar median survival. Overall survival was 70% at 1 year, 48% at 2 years, and 26% at 3 years. This case series of patients treated with chemoradiation for localized esophageal cancer suggest a generally well‐tolerated treatment with survival rates after chemoradiotherapy comparable with those seen with surgery.     

A case of spontaneous submucosal dissection of the esophagus

We report a case of spontaneous submucosal dissection of the esophagus of a 58-year-old patient. In September 2005, he complained of chest pain followed by vomiting. Endoscopy showed an ulcerative lesion in the entire circumference of the middle esophagus. No malignant cells were observed in biopsy specimen. The patient received therapy with hyperalimentation, a proton pump inhibitor, and Alloid G. The lesion healed under conservative treatment with a good clinical course and without the development of stenosis. One year later, we performed 24-h pH monitoring and esophageal manometry to clarify the pathogenesis of submucosal dissection in this patient. There was no gastroesophageal reflux, but the manometry test revealed decreased amplitude in the portion of the esophageal lesion that was considered to be caused by fibrosis resulting from inflammation. Two years later, the patient had no complaint of dysphagia. Further follow-up is needed for such a case.     

Primary malignant melanoma of esophagus following chemoradiotherapy for esophageal squamous cell carcinoma: report of a case

Primary malignant melanoma of the esophagus (PMME) is a rare neoplasm. We observed a case of PMME that had occurred at an irradiated site in the thoracic esophagus. The patient was a 74-year-old man who had received definitive chemoradiotherapy for esophageal squamous cell carcinoma at the age of 68, and had completely recovered. Six years later, via periodic upper gastrointestinal endoscopy, he had been diagnosed with esophageal tumors. After the patient underwent esophagectomy, the removed esophageal tumors were immunohistologically diagnosed as PMME, and most of the tumor was observed to be located within the irradiated area corresponding to the previous radiotherapy. The patient has been free of recurrence and metastasis and alive for 20 months after the second surgery without any additional treatment. The clinical course of this patient suggests that therapeutic radiation may be a factor in the occurrence of PMME.     

Direct Intraesophageal Growth from Metastatic Mediastinal Lymphadenopathy in Thymic Carcinoma

We herein report a case of thymic carcinoma that initially exhibited dysphagia and an intraesophageal mass lesion. A 68-year-old man was admitted to our hospital because of dysphagia. An endoscopic examination revealed a mass on the middle esophagus. Chest computed tomography (CT) showed a huge anterior mediastinal mass and subcarinal lymph node swelling, directly invading into the esophageal lumen. An immunohistological examination of the esophageal and anterior mediastinal masses revealed squamous cell carcinoma originating from the thymus. This is the first report of a thymic carcinoma spreading into the esophageal lumen and forming a mass lesion.     

超细胃镜下钛镍记忆合金覆膜食管支架置入术36例分析

食管支架置入术可有效改善不能行切除的晚期食管癌患者的吞咽困难症状,提高其生活质量。目的:探讨超细胃镜在钛镍记忆合金覆膜食管支架置入术中的临床价值。方法:对36例晚期食管癌、贲门癌合并吞咽困难患者行超细胃镜下钛镍记忆合金覆膜食管支架置入术,选取27例行普通内镜下食管支架置入术的患者作为对照,严重狭窄者预扩张至7 mm。分析支架置放成功率、定位准确性、支架膨胀扩张效果以及患者依从性和并发症情况。结果:超细胃镜组支架置放成功率100%,定位准确,自膨满意,术后吞咽困难评分显著改善(3.22对0.77),患者依从性和各种并发症发生率均优于对照组。结论:超细胃镜下钛镍记忆合金覆膜食管支架置入术成功率高,定位准确,操作简便,患者依从性好。     

Intraluminal high dose rate brachytherapy of tumorous esophageal stenoses

BACKGROUND/AIMS: The prognosis of inoperable carcinomas of esophagus is poor, and therapeutic efforts are generally limited to palliation. The aim of this study was to retrospectively evaluate the effectiveness of intraluminal high dose rate brachytherapy in the palliative treatment of tumorous esophageal stenoses. METHODOLOGY: Between February 1997 and July 2002 intraluminal brachytherapy was performed in 19 patients with inoperable esophageal carcinoma (squamous cell carcinoma in 14 cases and adenocarcinoma in 5 cases). All patients had dysphagia at presentation. Brachytherapy was performed using high dose rate afterloading system. RESULTS: Dysphagia was improved in all patients. The mean survival was 248 days. No mechanical complications were observed during introduction of the applicator. CONCLUSIONS: Our experience indicates that intraluminal brachytherapy is an effective and safe method of palliation of dysphagia caused by malignant esophageal stenosis.     

Photodynamic therapy and endoscopic metal stent placement for esophageal papillomatosis associated with squamous cell carcinoma

Esophageal squamous papillomatosis is a rare condition associated with human papilloma virus infection and has been complicated by the development of squamous cell carcinoma. Photodynamic therapy using porfimer sodium has been used for the treatment of esophageal cancer but has not been utilized in the treatment of esophageal squamous papillomatosis. We report here the first case of papillomatosis and obstructing squamous cell carcinoma of the esophagus palliated with porfimer sodium photodynamic therapy indicating successful photosensitizer uptake in papilloma-laden tissue. Extensive debulking of papilloma and tumor allowed esophageal recanalization and placement of a self-expanding metal stent for long-term dysphagia palliation. This unique case highlights the combined use of endoscopic techniques for optimal treatment results.