A Case of Esophageal Carcinoma and Collision Tumor of the Stomach

A case of double primary cancer of the esophagus and stomachwith metastasis of the esophageal cancer to the stomach is reported.The entire stomach and the lower part of the esophagus weresurgically resected and intrathoracic esophagojejunostomy wasperformed. Macroscopically, two tumors were found to be present,both in the lower esophagus and the stomach. There were twoprimary cancers, one a squamous cell carcinoma of the esophagusand the other a collision tumor of the stomach which consistedof well-differentiated adenocarcinoma and signet ring cell carcinoma.Furthermore, this collision tumor was present together witha metastatic lesion from the esophageal carcinoma.     

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.     

Pull-Through Esophagectomy Without Thoracotomy

Twenty patients with carcinoma of the hypopharynx, esophagusand thyroid underwent pull-through esophagectomy. Seventeenof them received combined resection of the larynx and trachea.Dissection of the lymph nodes at the upper mediastinum was performedin 11 patients by sternotomy. Seven patients received mediastinaltracheostomy after combined resection of the trachea and thelarynx. Pull-through esophagectomy was followed by pharyngogastrostomywithout thoracotomy via the posterior mediastinum. This techniqueis described in detail. Because there is no thoracotomy andligation of the esophageal vessels is ensured, no pulmonarycomplications and no massive mediastinal hemorrhages occurred.There were no operative deaths. This operation offers excellentpalliation and little morbidity. Moreover, the use of sternotomyand mediastinal tracheostomy for pull-through esophagectomymade it possible to dissect the upper mediastinal lymph nodes,and we could resect the affected trachea with certainty.     

Esophageal Cancer Associated with Gastric Cancer

Among a total of 1,137 patients with esophageal cancer, therewere 44 cases of esophageal cancer associated with gastric cancer,an incidence of 3.9%. The majority of the patients were between60 and 70 yr old. Forty-two patients were male and two werefemale. Eleven of these patients had a third cancer. Six had multiplecancers in the esophagus and/or stomach. Eighteen patients hadearly gastric cancer. Thirty-two of the cancers were synchronousand 12 were metachronous. Of these 44 patients, 21 had familyhistories of cancer, 37 were smokers, and 36 were drinkers.Twenty-five patients received surgery for all of their cancers,and two patients received resection of only esophageal cancer.Of these 27 patients. five patients lived more than 5 yr. Themost frequent cause of death in our series was esophageal cancer(52.9%). Surgical treatment of all of the cancers is desirable. Whenthis is impossible, the surgery must be emphasized for the esophagealcancer in most cases.     

Double Adenocarcinoma in Barrett's Esophagus: A Case Report

At the National Cancer Center Hospital in Tokyo, a patient withBarrett's esophagus developed double adenocarcinoma of the esophagus.One carcinoma was located in the midesophagus and the otherjust above the anatomic cardia. Esophagoscopic examination withbiopsy revealed two carcinomas surrounded with columnar epitheliumand ectopic islets of gastric mucosa situated in the postcricoidregion. There was no ulcer or stricture in the esophagus. Thepatient received subtotal esophagectomy and survived the operation.Microscopically, depth of invasion of the proximal cancer wasto the proper muscle, and that of the distal one was to thesubmucosal layer. There was metastasis to two lymph nodes. Therewas no sign of inflammation or ulcer in the esophagus.     

A Case of Concomitant Association of Early Esophageal Carcinoma, Early Gastric Carcinoma and Malignant Lymphoma of the Stomach

A case of concomitant association of early esophageal carcinoma,cancer of the early gastric carcinoma and malignant lymphomaof the stomach was reported. The intrathoracic esophagus wasresected with the whole stomach, and the esophagus was reconstructedwith the right side colon. There were two separate early carcinomasin the upper and lower esophagus. The upper lesion was intraepithelialsquamous cell carcinoma, and the extension of lower lesion alsolimited in the intraepithelial layer. He had also signet ringcell carcinoma of the stomach which was limited only in themucosal layer. In addition, there was malignant lymphoma invadedinto the mucosa and sub-mucosa at the antral rigion of the stomach.There was no lymph node metastasis. The patient is living wellnow. The association of early esophageal carcinoma with earlystomach carcinoma is rare. Only five such cases have been reportedin the Japanese literature.     

Primary Adenocarcinoma of the Esophagus Report of Six Cases

Six primary adenocarcinomas were found among 1,346 cases ofesophageal carcinoma, an incidence of 0.45%. Three of the adenocarcinomaswere the "type ordinaire" of Lortat-Jacob, two were adenoidcystic carcinoma, and one was mucoepidermoid carcinoma. Theinitial symptom was dysphagia in all six cases. All six lesionswere located in the middle and/or lower third of the esophagus.Esophagograms showed tumorous-type lesions in four cases andspiral-type in two cases. Although endoscopical examinationwas performed in five cases, the biopsied specimen showed adenocarcinomasin only two. Four patients were operated and on two receivedradiation therapy. Four patients died within one year, and twoare still alive more than 21 months after surgery.