부산대학교 도서관

A 55-year-old man admitted for hematemesis and dysphagia had severe anemia, Hb 3.9g/dl. Serum alphafetoprotein (AFP) was extremely high at 47, 800ng/ml. Gastrointestinal endoscopy showed an elevated lesion in the lower esophagus extending to the esophagogastric junction. Computed tomography showed multiple lung metastases. Emergency surgery for uncontrollable bleeding from the tumor in laparotomy and a transhiatus approach, involved distal esophagectomy and reconstruction using a subtotal gastric tube. In histological examination, the tumor was diagnosed as esophageal adenocarcinoma similar to hepatic cell carcinoma. Immunohistochemical study indicated positive AFP. The tumor was AFP-producing adenocarcinoma of the esophagus. After surgery, serum AFP decreased to 1, 900ng/ml. The patient was discharged on postoperative day 10. Despite adjunctive chemotherapy, he developed lung and bone metastases with increasing serum AFP, eventually dying 9 months after surgery. Only 6 such cases have been reported previously in Japan. In addition, we discussed problems on the classification of adeocarcinoma at the esophagogastiric junction.