Collision Cancer between Squamous Cell Carcinoma and Adenocarcinoma at the Esophagogastric Junction

Akira Umemura, Michihiko Kitamura, Masashi Sawada¹⁾, Takumi Kato²⁾, Akiko Umemura, Kaori Shibuya, Shunsuke Shibuya, Kazuyuki Kusuda, Yu Suzuki and Yoshihiro Endo

Department of Surgery, Iwate Prefectural Isawa Hospital
Department of Surgery, Hanamaki General Hospital¹⁾
Department of Advanced Surgical Science and Technology, Graduate School of Medical Sciences, Tohoku University²⁾

Collision carcinoma at the esophagogastric junction (EGJ) is rare. We report an unusual case of collision cancer between squamous cell carcinoma from the esophagus and adenocarcinoma from the gastric cardia. An 85-year-old man reporting dysphagia was found in endoscopic examination to have a large ulcerated tumor at the EGJ, initially considered esophageal cancer with gastric invasion. Histological examination of the biopsy specimen, however, showed both poor differentiated squamous cell carcinoma and tubular adenocarcinoma. We resected the lower esophagus and conducted total gastrectomy combined with mediastinal and abdominal lymph node dissection. We fashioned an esophagojejunostomy using Roux-en Y reconstruction. Histological examination of the resected specimen showed esophageal squamous cell carcinoma colliding with gastric adenocarcinoma with a distinct intervening border and no morphological transition. One of dissected lymph nodes was contained both. Collision tumors are difficult to detect and diagnose before determination of their histological findings. Clinicians must therefore be aware of the possibility of collision carcinoma when they detect tumors rising from the EGJ.

Key words
collision carcinoma, esophagogastric junction, esophageal cancer

Reprint requests
Akira Umemura Department of Surgery, Iwate Prefectural Isawa Hospital
61 Ryugababa, Mizusawa, Ohsyu, 023-0864 JAPAN

Accepted
February 18, 2009

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