A Case of Scirrhous-Type Gastric Cancer in the Gastric Tube of a Patient Previously Treated for Thoracic Esophageal Cancer

Kouji Tobita, Shinichi Okazumi, Hisahiro Matsubara, Hideaki Shimada and Takenori Ochiai

Graduate School of Medicine, Chiba University Department of Academic Surgery

We report a case of scirrhous gastric cancer in the gastric tube of a patient who had previously undergone radical resection for thoracic esophageal cancer. The 78-year-old man diagnosed with 2 types of IIc esophageal cancer (Mt and Lt) underwent right thoracolaparotomy, thoracic esophagotectomy, and retrosternal reconstruction with a gastric tube on October, 1993. The depth of invasion of the Mt lesion was pEP and that of the Lt lesion pMM. The tumor was classified as pN0M0, pStage0. Postoperatively he did well and was followed up closely with annual upper endoscopy. On December, 1997, 4 years and 1 month after initial surgery, upper endoscopy revealed a hypertrophic lesion with surrounding erythema at the body along the lesser curvature of the reconstructed gastric tube. The biopsy specimen showed signet-ring cell carcinoma. Scirrhous gastric cancer was suggested, necessitating, total resection of the gastric tube with median sternotomy, conducted on February, 1998. The pathological diagnosis of the resected specimen was poorly differentiated adenocarcinoma with invasion to the muscularis propria (ly1, v0, PM (-), DM (-), n0). The patient died of recurrence after 2 years of follow-up after the second operation. It is difficult to diagnose scirrhous cancer of the gastric tube endoscopically. Physcians should thus have a low threshold for conducting biopsies of even slightly suspicious areas.

Key words
scirrhous gastric cancer, cancer in reconstructed gastric tube, esophageal cancer

Reprint requests
Kouji Tobita Department of Surgery, Shimotsuga General Hospital
5-32 Fujimi-cho, Tochigi, 328-8505 JAPAN

Accepted
February 25, 2004

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