经内镜黏膜下剥离术治疗的膈上憩室内浅表食管癌。
A superficial esophageal cancer in an epiphrenic diverticulum treated by endoscopic submucosal dissection.
作者信息
Fu Kuangi, Jin Peng, He Yuqi, Suzuki Masanori, Sheng Jianqiu
机构信息
Department of Gastroenterology, Kanma Memorial Hospital, 2-5, Nasushiobara city, Tochigi, 325-0046, Japan.
Department of Gastroenterology, PLA Army General Hospital, Beijing, 100700, China.
出版信息
BMC Gastroenterol. 2017 Aug 7;17(1):94. doi: 10.1186/s12876-017-0649-y.
BACKGROUND
We report a unique case of a superficial esophageal cancer arising in a single diverticulum, diagnosed with magnifying image-enhanced endoscopy and then successfully treated by endoscopic submucosal dissection (ESD).
CASE PRESENTATION
A 66-year-old man with alcohol-related liver injury visited our hospital for endoscopy for investigation of varix. Esophagogastroduodenoscopy showed no varix but a large epiphrenic diverticulum with an area of fainted redness just above the esophagogastric junction. Narrow band imaging revealed a sharply demarcated brownish dotted area, and dilated intra-epithelial papillary capillary loops (IPCL) were subsequently seen after magnification. Chromoendoscopy with 1% Lugol's iodine solution demonstrated a well-demarcated unstained area, approximately 20 mm in diameter. Endoscopic biopsy revealed a squamous cell carcinoma (SCC).
CONCLUSION
The tumor was completely resected by ESD without perforation. Histologically, it was an intraepithelial SCC without lympho-vascular invasion of cancer cells. No local recurrence or metastasis was detected at the last follow-up of 42 months.
背景
我们报告了一例罕见的浅表食管癌病例，该肿瘤起源于单个憩室，通过放大内镜图像增强技术得以诊断，并随后成功接受了内镜黏膜下剥离术（ESD）治疗。
病例介绍
一名患有酒精相关性肝损伤的66岁男性因静脉曲张检查前来我院接受内镜检查。食管胃十二指肠镜检查未发现静脉曲张，但发现一个巨大的膈上憩室，在食管胃交界处上方有一片淡红色区域。窄带成像显示有一个边界清晰的褐色点状区域，放大后可见扩张的上皮内乳头样毛细血管袢（IPCL）。用1%卢戈氏碘溶液进行色素内镜检查显示有一个边界清晰的不着色区域，直径约20毫米。内镜活检显示为鳞状细胞癌（SCC）。
结论
肿瘤通过ESD完整切除，未发生穿孔。组织学检查显示为上皮内SCC，癌细胞无淋巴管侵犯。在42个月的最后随访中未发现局部复发或转移。
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