A Case of Esophageal Cancer Suspected Hematogenous Metastasis to Submucosal Layer of Cardia after Chemoradiotherapy and Endoscopic Submucosal Dissection

Takayoshi Niwa, Sachiyo Nomura, Kazuhiko Yamada, Keichi Jimbo, Makoto Okamoto¹⁾, Hiroshi Uozaki²⁾ and Michio Kaminishi

Department of Gastrointestinal Surgery, Department of Gastroenterology¹⁾ and Department of Pathology²⁾, The University of Tokyo Hospital

A 63-year-old man diagnosed with esophageal cancer in July 2002 had pathological findings of well-differentiated squamous cell carcinoma (SCC) of clinical stage III (MtUtLt, T3-4, N2) based on Japanese Guidelines for clinical and pathological studies on esophageal carcinoma. Direct invasion to the left main bronchus was suspected, necessitating chemoradiotherapy (5-FU, cysplatin for 2 series) and radiotherapy (RT) (65 Gy). In December 2002, his response was complete recoverly (CR) for the tumor and partial recovery (PR) for lymph node metastasis. In September 2003, a mucosal irregularity of the entire esophageal wall circumference detected 40-45 cm distal from the fore-tooth that was not dyed by Lugol iodine solution was diagnosed as esophageal cancer. Another round of RT and chemotherapy (FP) was done, but a clinical evaluation of no change (NC), necessitated endoscopic mucosal dissection. The pathological finding was squamous cell carcinoma. (m1, ly0, v0) In August 2004, the findings of carcinoma of the hypopharynx necessitated partial pharyngectomy and lymph node dissection. In January 2006, detection of an elevated submucosal tumor like lesion in the cardiac part of the stomach was found in fine-needle aspiration to be SCC, necessitating proximal gastrectomy in April 2006, and pathological findings of moderately differentiated SCC with severe venous invasion. This tumor appeared to have arisen through hematogenous metastasis from the first esophageal cancer.

Key words
esophageal cancer, intramural metastasis, hematogenous metastasis

Reprint requests
Sachiyo Nomura Department of Gastrointestinal Surgery, The University of Tokyo
7-3-1 Hongo, Bunkyo-ku, 113-8655 JAPAN

Accepted
December 19, 2007

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