Suganuma Takanori, Yoon Han-Seung
Iida Municipal Hospital, Iida, Japan.
Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
GE Port J Gastroenterol. 2018 Mar;25(2):80-85. doi: 10.1159/000479432. Epub 2017 Aug 24.
We report a rare case of extensive esophageal squamous papillomas (ESPs) involving the entire esophagus and florid cardiac gland hyperplasia involving only the lower esophagus in a 39-year-old woman with heartburn and epigastric distress for the past 2 years. Previous esophagogastroduodenoscopy showed multiple ESPs involving the entire esophagus extending 38 cm from the esophageal orifice to the esophagogastric junction (EGJ). Additionally, prominent cardiac gland hyperplasia over the esophageal posterior wall was exhibited extending 12 cm from the mid-esophagus to the EGJ. A biopsy obtained from the ESP area showed typical squamous papillomas and cardiac gland hyperplasia with no evidence of koilocytosis or malignancy. Polymerase chain reaction was negative for a variety of human papilloma virus DNAs. Subsequently, Siewert type II gastric cancer with submucosal elevation of the stomach was detected at the EGJ. Endoscopy showed a 20-mm-thick lesion appearing to extend to the muscularis propria; subsequent biopsy showed invasive adenocarcinoma. Total gastrectomy with D2 lymph node dissection, splenectomy, and Roux-en-Y reconstruction were performed for the EGJ cancer. The patient died from widespread multiorgan metastasis within 2 years following surgery.
我们报告了一例罕见病例，一名39岁女性，过去两年有烧心和上腹部不适症状，其整个食管均有广泛的食管鳞状乳头状瘤（ESPs），仅下食管有显著的贲门腺增生。既往食管胃十二指肠镜检查显示多个ESPs累及整个食管，从食管入口延伸至食管胃交界（EGJ）达38 cm。此外，食管后壁可见明显的贲门腺增生，从中段食管延伸至EGJ达12 cm。取自ESPs区域的活检显示为典型的鳞状乳头状瘤和贲门腺增生，未见挖空细胞或恶性肿瘤证据。聚合酶链反应检测多种人乳头瘤病毒DNA均为阴性。随后，在EGJ处检测到Siewert II型胃癌伴胃黏膜下隆起。内镜检查显示一个20 mm厚的病变，似乎延伸至固有肌层；随后的活检显示为浸润性腺癌。对EGJ癌患者进行了D2淋巴结清扫的全胃切除术、脾切除术和Roux-en-Y重建术。患者术后2年内死于广泛的多器官转移。
