内容紹介
Summary
We report a case of metachronous gastric intramural metastasis following esophageal cancer endoscopic submucosal dissection(ESD). The patient was an 80s man who was referred to the department of gastroenterology of our hospital for early-stage esophageal cancer by a local physician. ESD was performed for a lesion(Lt, 0-Ⅱa+Ⅱc, cT1N0M0, StageⅠ)located 35-38 cm from the incisors. Pathologic diagnosis revealed that the lesion was a 2.5×2.0 cm-sized, pSM2, 506 μm, well-differentiated squamous cell carcinoma, ly+, v-, pHM0, pVM0. The patient was indicated for additional treatment, but because the patient requested not to undergo operative treatment, radiation therapy, or chemotherapy, strict follow-up was performed. Upper endoscopy performed 1 year after ESD revealed the presence of a submucosal tumor(diameter of 5 cm)accompanied by ulceration in the gastric cardia, and biopsy findings led to the diagnosis of squamous cell carcinoma. The patient was referred to our department for operative treatment, and considering the possibility of primary squamous cell carcinoma of the stomach, we performed total gastrectomy(D2 dissection, Roux-en-Y)and cholecystectomy. The pathologic diagnosis was well-differentiated squamous cell carcinoma, ly1, v0, SE, N1. Because esophageal cancer and the tissue type were consistent and the primary locus of the tumor was the submucosal layer, the patient was diagnosed with esophageal cancer with gastric intramural metastasis. We report a rare case of metachronous gastric intramural metastasis of esophageal cancer along with a review of the literature.
要旨
食道癌粘膜下層剝離術(endoscopic submucosal dissection: ESD)施行後に異時性胃壁内転移を来した1例を経験したので報告する。症例は80代,男性。当院消化器内科にて早期食道癌に対しESDを施行した。pSM2,浸潤距離506 μm,ly+であったが患者が手術と化学放射線療法を希望せず,経過観察の方針となった。ESDより1年後の上部消化管内視鏡検査で胃噴門部に約5 cmの粘膜下腫瘍を認め,生検にて扁平上皮癌と診断した。手術目的に当科紹介となり,胃全摘術(D2郭清,Roux-en-Y再建),胆囊摘出術を行った。病理組織学的検査にて,食道癌と組織型が一致し腫瘍の主座が粘膜下層であることから,食道癌胃壁内転移と診断した。
目次
We report a case of metachronous gastric intramural metastasis following esophageal cancer endoscopic submucosal dissection(ESD). The patient was an 80s man who was referred to the department of gastroenterology of our hospital for early-stage esophageal cancer by a local physician. ESD was performed for a lesion(Lt, 0-Ⅱa+Ⅱc, cT1N0M0, StageⅠ)located 35-38 cm from the incisors. Pathologic diagnosis revealed that the lesion was a 2.5×2.0 cm-sized, pSM2, 506 μm, well-differentiated squamous cell carcinoma, ly+, v-, pHM0, pVM0. The patient was indicated for additional treatment, but because the patient requested not to undergo operative treatment, radiation therapy, or chemotherapy, strict follow-up was performed. Upper endoscopy performed 1 year after ESD revealed the presence of a submucosal tumor(diameter of 5 cm)accompanied by ulceration in the gastric cardia, and biopsy findings led to the diagnosis of squamous cell carcinoma. The patient was referred to our department for operative treatment, and considering the possibility of primary squamous cell carcinoma of the stomach, we performed total gastrectomy(D2 dissection, Roux-en-Y)and cholecystectomy. The pathologic diagnosis was well-differentiated squamous cell carcinoma, ly1, v0, SE, N1. Because esophageal cancer and the tissue type were consistent and the primary locus of the tumor was the submucosal layer, the patient was diagnosed with esophageal cancer with gastric intramural metastasis. We report a rare case of metachronous gastric intramural metastasis of esophageal cancer along with a review of the literature.
要旨
食道癌粘膜下層剝離術(endoscopic submucosal dissection: ESD)施行後に異時性胃壁内転移を来した1例を経験したので報告する。症例は80代,男性。当院消化器内科にて早期食道癌に対しESDを施行した。pSM2,浸潤距離506 μm,ly+であったが患者が手術と化学放射線療法を希望せず,経過観察の方針となった。ESDより1年後の上部消化管内視鏡検査で胃噴門部に約5 cmの粘膜下腫瘍を認め,生検にて扁平上皮癌と診断した。手術目的に当科紹介となり,胃全摘術(D2郭清,Roux-en-Y再建),胆囊摘出術を行った。病理組織学的検査にて,食道癌と組織型が一致し腫瘍の主座が粘膜下層であることから,食道癌胃壁内転移と診断した。