Report of a Case Undergone Successful Gastrectomy for Gastric Cancer in the Fornix with Esophageal Mycosis

Taichi Shuto, Masayuki Higashino, Harushi Osugi, Mitsuo Hai, Noriaki Maekawa, Satoshi Ueno, Harunori Yasuda, Taigou Tokuhara, Shinya Tanimura, Yousuke Fukunaga, Hiroaki Kinoshita

Second Department of Surgery, Osaka City University Medical School

A 76-year-old man had been on oral antidiabetics for 10 years. Four years ago, mild dysphagia led him to undergo esophageal studies, which revealed that he had esophageal mycosis. He had been on antifungal agents and received periodic upper gastrointestinal series studies since then. Three years after the diagnosis, an elevated lesion was found in the fornix of the stomach. As an endoscopic biopsy revealed adenocarcinoma in the lesion, a laparotomy was performed. The abdominal esophagus was markedly thickened due to the known mycosis and was thought to be unsuitable for anastomosis. Because the lesion was located 3 cm away from the esophago-gastric junction and the lesion was not the infiltrating type, the stomach was resected nearly totally with R2 lymph node dissection, preserving the stomach 1 cm from the junction. Despite the severe diabetes mellitus, the patient recovered uneventfully. No report of gastrectomy for gastric cancer with esophageal mycosis had been found. In the case of esophageal mycosis, even esophageal stripping should be considered to achieve complete resection of the cancer and safe anastomosis. In our case, a free and safe surgical margin was fortunately obtained in the stomach.

Key words
esophageal mycosis, gastric carcinoma, complication after gastrectomy

Reprint requests
Taichi Shuto Second Department of Surgery, Osaka City University Medical School
1-5-7 Asahi-machi, Abeno-ku, Osaka, 545 JAPAN

Accepted
December 12, 1990

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