Toyota Satoshi, Kimura Yasue, Fujimoto Yoshiaki, Jogo Tomoko, Hu Qingjiang, Hokonohara Kentaro, Nakanishi Ryota, Hisamatsu Yuichi, Ando Koji, Oki Eiji, Oda Yoshinao, Miyashita Yu, Kohashi Kenichi, Mori Masaki
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan.
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Int Cancer Conf J. 2020 Jul 18;9(4):231-234. doi: 10.1007/s13691-020-00434-2. eCollection 2020 Oct.
A 75-year-old man was admitted to our hospital for treatment of esophageal cancer (EC) in March 2017. Esophagogastroduodenoscopy revealed Barrett's esophagus and superficial, distal EC (type 0-IIc). Tumor biopsy showed esophageal adenocarcinoma. Computed tomography revealed no lymph node metastasis but did reveal a 19-mm tumor on the right side of the urinary bladder. Bladder cancer (BC) was also suspected, and the patient underwent endoscopic submucosal dissection for EC and transurethral resection of the bladder tumor. The pathological diagnosis of EC was moderately to poorly differentiated adenocarcinoma (tub2), pT1b (SM), ly0, v0. The pathological horizontal margin was negative and the vertical margin was positive. Additional esophagectomy and lymph node dissection were indicated for curability. Esophagectomy was difficult because the patient had severe cardiovascular disease, so follow-up observation was adopted. BC was classified as urothelial carcinoma Ta, ly0, v0. After 32 months, multiple tumors were found in the bladder, and BC recurrence was suspected. Transurethral resection of the bladder was performed again for seven tumors, and pathological diagnosis was poorly differentiated adenocarcinoma (tub2). The immunohistochemical features matched those of EC. We diagnosed EC metastasis in the urinary bladder. Bladder adenocarcinoma is difficult to distinguish from metastasis from other organs, especially the upper gastrointestinal tract, and cytomorphological features and appropriate clinical history are required.
一名75岁男性于2017年3月因食管癌（EC）入院接受治疗。食管胃十二指肠镜检查发现巴雷特食管和浅表性远端EC（0-IIc型）。肿瘤活检显示为食管腺癌。计算机断层扫描显示无淋巴结转移，但确实在膀胱右侧发现一个19毫米的肿瘤。也怀疑有膀胱癌（BC），该患者接受了EC的内镜黏膜下剥离术和膀胱肿瘤经尿道切除术。EC的病理诊断为中分化至低分化腺癌（tub2），pT1b（SM），ly0，v0。病理切缘水平为阴性，垂直切缘为阳性。为达到治愈目的，需行额外的食管切除术和淋巴结清扫术。由于患者患有严重的心血管疾病，食管切除术难度较大，因此采取了随访观察。BC分类为尿路上皮癌Ta，ly0，v0。32个月后，在膀胱中发现多个肿瘤，怀疑BC复发。再次对七个肿瘤进行了膀胱经尿道切除术，病理诊断为低分化腺癌（tub2）。免疫组化特征与EC相符。我们诊断为EC转移至膀胱。膀胱腺癌难以与其他器官尤其是上消化道转移瘤相区分，需要细胞形态学特征和适当的临床病史。
