Matsutani Takeshi, Hagiwara Nobutoshi, Nomura Tsutomu, Fujita Itsuo, Kanazawa Yoshikazu, Kakinuma Daisuke, Matsuda Akihisa, Uchida Eiji
Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Bunkyo-ku, Tokyo, 113-8603, Japan.
Clin J Gastroenterol. 2018 Apr;11(2):113-117. doi: 10.1007/s12328-017-0803-7. Epub 2017 Nov 27.
Asymptomatic T1 (invaded submucosa) esophageal carcinoma rarely metastasizes to the brain. A 53-year-old Japanese man complaining of right hemiparesis and convulsion was admitted to our hospital. Brain imaging demonstrated a ring-like, enhanced brain tumor in the left parietal lobe. The pathological findings of the resected tumor were consistent with a metastatic adenocarcinoma from the gastrointestinal tract. Additional examinations revealed an elevated-type tumor in the lower third of the thoracic esophagus. The patient underwent thoracoscopic esophagectomy with lymph node dissection followed by reconstruction with gastric tube substitution. The immunohistochemical findings of the resected specimen were similar to those of the metastatic brain tumor. Although the patient received adjuvant chemotherapy (5-fluorouracil, docetaxel plus cisplatin), a solitary small brain metastasis was detected 4 months after esophagectomy. Excision of the sequential metastases with whole-brain radiation therapy and gamma-knife therapy were performed. The patient survived for 50 months after beginning the initial treatment. This report describes a rare case of brain metastases from T1 esophageal adenocarcinoma in a patient without gastrointestinal symptoms.
无症状的T1期（侵犯黏膜下层）食管癌很少转移至脑。一名53岁的日本男性因右侧偏瘫和惊厥入院。脑部影像学检查显示左顶叶有一个环状强化脑肿瘤。切除肿瘤的病理结果与胃肠道转移性腺癌一致。进一步检查发现胸段食管下三分之一处有一隆起型肿瘤。患者接受了胸腔镜下食管切除术及淋巴结清扫，随后用胃管替代进行重建。切除标本的免疫组化结果与转移性脑肿瘤相似。尽管患者接受了辅助化疗（5-氟尿嘧啶、多西他赛加顺铂），但在食管切除术后4个月检测到一个孤立的小脑转移灶。对相继出现的转移灶进行了全脑放射治疗和伽玛刀治疗。患者在开始初始治疗后存活了50个月。本报告描述了一例无胃肠道症状患者发生T1期食管腺癌脑转移的罕见病例。
