A Case of Esophageal Mucosal Carcinoma with Intramural and Lymph Node Metastsis

Sumiya Ishigami, Shoji Natsugoe, Toshiyuki Morinaga, Heiji Yoshinaka, Masamichi Baba, Toshitaka Fukumoto, Takashi Aikou, Hisaaki Shimazu

First Department of Surgery, Kagoshima University School of Medicine

The patient was a 75-year-old man, who was admitted to our surgical clinic with a complaint of dysphagia. Esophagoscopy with Lugol staining examination revealed a superficially erosive lesion in the middle esophagus, which was histopathological diagnosed as squamous cell carcinoma. The lesion was probably confined to the mucosa. However, endoscopic ultrasonography demonstrated a lesion located submucosally and mainly in the proper muscule layer near the erosive cancer lesion mentioned above. Regional lymph node metastasis was also suggested. Therefore, subtotal esophagectomy with regional lymph node dissection was carried out under right thoracotomy and laparotomy. Histopathologic examination of the resected specimen revealed four small mucosal cancers and submucosal metastatic lesion in the middle esophagus as well as metastasis in the paraesophgeal and paratracheal lymph nodes. Since no other primary malignancy was found, the esophageal mucosal cancers were considered to be responsible for the intrmural metastasic lesion. Although such esophageal mucosal cancer is very rare, the possibility should be borne in mind, especially in connection with the indications for limited operation and endoscopic mucosal resection.

Key words
esophageal mucosal carcinoma, intramural metastasis, lymph node metastasis

Reprint requests
Sumiya Ishigami First Department of Surgery, Kagoshima University School of Medicine
8-35-1 Sakuragaoka, Kagoshima, 890 JAPAN

Accepted
September 8, 1993

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