부산대학교 도서관

The patient was a 61-year-old man, who sought medical care for epigastralgia provoked by swallowing. Upper endoscopy revealed a Mt IIc lesion 3 cm in the major axis halfway around the esophagus and a biopsy established a diagnosis of squamous cell cancer (Mt 0-IIc T1a [lpm] [halfway around the circumference] Stage 0. ESD was performed under general anesthesia. On histopathological examination, the lesion was a poorly differentiated squamous cell cancer 22 mm in diameter (sm1, ly1, v1, HM0, VM0). Additional therapy of 5 courses of FP (5FU+CDDP) was conducted at the patient's request. Follow-up CT disclosed an approximately 3 cm mass in the region of the thoracic descending aorta at 14 months of ESD. The mass was diagnosed as lymph node metastasis and a right thoracotomy was performed for subtotal excision of the esophagus as well as lymphadenectomy.Clinically there were lymph node metastases around the thoracic aorta, while histologically the lesion was endocrine cell carcinoma. The excised esophagus was free of cancer remnants. Lung and bone metastases were detected at 3 months of reoperation for the recurrence that occurred in spite of 60 Gy radiotherapy as well as FP chemotherapy. The patient died of the primary disease at 25 months after the initial therapy, 10 months from the esophageal resection. We report herein on a patient with a highly malignant esophageal cancer with a neuroendocrine component that was hard to recognize from ESD specimens and who died after recurrent lymph node metastases.