Tobari Shoichi, Ikeda Yoshifumi, Kurihara Hideko, Takami Hiroshi, Okinaga Kota, Kodaira Susumu
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1027-9.
A 78-year-old man reported a persistent midthoracic pain, mild dysphagia, and an abdominal distention. An abdominal computed tomography scan showed massive ascites, extensive paracardial mass, a large mass which invaded the pancreas, and a mass of multiple para-aortic lymphadenopathies which involved the superior mesenteric artery. An upper gastrointestinal endoscopic study revealed an infiltrative, ulcerating tumor of the lower esophagus. Histological study of the biopsy specimens from esophageal tumor showed small cell carcinoma. After combination chemotherapy, an abdominal computed tomography scan showed a disappearance of asites, a partial response reduction of paragastric mass, peripancreatic mass and para-aortic lymphadenopathies. Histological study of the biopsy specimens from esophageal tumor showed a viable small cell carcinoma. In June 2001, the patient underwent lower esophagectomy and proximal gastrectomy combined with splenectomy and distal pancreatectomy through an abdominal approach. Histological findings of the resected specimen showed that the esophageal tumor was a small cell carcinoma which invaded into the submucosal layer, and both paracardial and peripancreatic tumors, and all lymph nodes had no cancer cells. The patient's postoperative recovery was uneventful and discharged without aggressive chemotherapy postoperatively. However, he eventually died of progression of the metastasis 21 months after first detection of the carcinoma. Patients with esophageal small cell carcinoma treated with surgery following chemotherapy and/or radiotherapy have been reported to survive longer than those treated with chemotherapy and/or radiotherapy. Therefore, surgical resection may be recommended as the second therapy that occasionally produces long-term remission and possibly long-term survival for patients with small cell carcinoma of the esophagus.
一名78岁男性报告有持续的胸中部疼痛、轻度吞咽困难和腹胀。腹部计算机断层扫描显示大量腹水、广泛的心包旁肿块、侵犯胰腺的大肿块以及累及肠系膜上动脉的多个腹主动脉旁淋巴结肿大。上消化道内镜检查显示食管下段有浸润性溃疡性肿瘤。食管肿瘤活检标本的组织学研究显示为小细胞癌。联合化疗后，腹部计算机断层扫描显示腹水消失，胃旁肿块、胰腺周围肿块和腹主动脉旁淋巴结肿大部分缩小。食管肿瘤活检标本的组织学研究显示小细胞癌仍存活。2001年6月，患者通过腹部入路接受了食管下段切除术、近端胃切除术，同时行脾切除术和远端胰腺切除术。切除标本的组织学检查结果显示，食管肿瘤为侵犯黏膜下层的小细胞癌，心包旁和胰腺周围肿瘤以及所有淋巴结均无癌细胞。患者术后恢复顺利，术后未进行强化化疗即出院。然而，他最终在首次发现癌症21个月后因转移进展而死亡。据报道，接受化疗和/或放疗后接受手术治疗的食管小细胞癌患者比接受化疗和/或放疗的患者存活时间更长。因此，手术切除可作为偶尔能使食管小细胞癌患者获得长期缓解并可能长期存活的二线治疗方法推荐。
