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Case Reports
. 2014 Jul-Aug;99(4):458-62.
doi: 10.9738/INTSURG-D-13-00069.1.

Mucosal esophageal squamous cell carcinoma with intramural gastric metastasis invading liver and pancreas: a case report

Nobuhiro Nakazawa  1 , Minoru Fukuchi, Shinji Sakurai, Hiroshi Naitoh, Shinsuke Kiriyama, Takaharu Fukasawa, Yuichi Tabe, Hayato Yamauchi, Masaki Suzuki, Tomonori Yoshida, Hiroyuki Kuwano
Affiliations
Case Reports

Mucosal esophageal squamous cell carcinoma with intramural gastric metastasis invading liver and pancreas: a case report

Nobuhiro Nakazawa et al. Int Surg. 2014 Jul-Aug.

Abstract

A 59-year-old Japanese man was admitted to our hospital because of a 1-month history of dysphagia. Endoscopic examination revealed a superficial esophageal squamous cell carcinoma and a giant gastric tumor. Computed tomography showed that the gastric tumor was directly invading the liver and pancreas. Because of the risk of the gastric tumor causing obstruction and bleeding, we performed a subtotal esophagectomy, proximal gastrectomy, left lateral segmentectomy of liver, and pancreatosplenectomy with gastric tube reconstruction. Final pathological findings were superficial esophageal carcinoma penetrating the muscularis mucosae with an intramural gastric metastasis directly invading the liver and pancreas. The patient received postoperative adjuvant chemotherapy, yet died 8 months postoperatively of complications of local recurrence. Early-stage esophageal carcinoma with intramural gastric metastasis is very rare. To our knowledge, this is the first case of mucosal esophageal carcinoma with intramural gastric metastasis directly invading other organs.

Keywords: Direct invasion; Intramural gastric metastasis; Mucosal esophageal carcinoma.

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Figures

Fig. 1
Fig. 1
Endoscopic examination. (a) A 2.0-cm-diameter, superficial, flat lesion was observed in the lower thoracic esophagus and delineated by iodine staining. (b) A 10-cm-diameter submucosal tumor was observed in the cardiac portion of the stomach.
Fig. 2
Fig. 2
A coronal CT slice revealed a gastric tumor directly invading the left lateral segment of the liver and the body of the pancreas.
Fig. 3
Fig. 3
Surgical specimens. (a) The esophageal tumor, a flat, 13 × 19-mm lesion in the lower portion of the esophagus, is delineated by iodine staining (arrow). (b) The gastric tumor is a 16 × 15 × 10-cm submucosal lesion in the cardiac portion of the stomach. (c, d) A sectioned slice of the gastric tumor shows direct invasion of the left lateral segment of the liver and the body of the pancreas.
Fig. 4
Fig. 4
Macroscopic examination. (a) The esophageal lesion is a poorly differentiated squamous cell carcinoma penetrating the muscularis mucosae. (b) The gastric lesion is also a poorly differentiated squamous cell carcinoma lying one layer deeper than the mucosa.
See this image and copyright information in PMC

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