Kuwayama Naoki, Hoshino Isamu, Gunji Hisashi, Tonooka Toru, Soda Hiroaki, Eto Ryotaro, Takiguchi Nobuhiro, Nabeya Yoshihiro
Division of Gastroenterological Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
Surg Case Rep. 2020 Sep 29;6(1):230. doi: 10.1186/s40792-020-00995-7.
Barrett's esophagus (BE) is characterized by presence of columnar epithelium in the lower esophageal mucosa, which originally comprises stratified squamous epithelium. Gastroesophageal reflux disease causes BE and BE adenocarcinoma (BEAC); further, the incidence of BEAC is increasing, especially in developed countries. Long-segment BE (LSBE) has a particularly high carcinogenic potential and necessitates treatment, surveillance, and prevention.
Herein, we report three cases of BEAC originating from LSBE larger than 15 cm. All three patients underwent surgery for the diagnosis of BEAC. A 66-year-old man with advanced esophageal cancer underwent neoadjuvant chemotherapy and subsequent subtotal esophagectomy. The postoperative pathological diagnosis was of poorly differentiated adenocarcinoma with lymph node metastasis (pT3 pN3 pM0 pStage III based on the Union for International Cancer Control TNM Classification 8th edition). Two years after the operation, the patient was diagnosed with recurrence around the celiac artery and underwent chemotherapy. An 83-year-old woman with advanced esophageal cancer underwent subtotal esophagectomy. The postoperative pathological diagnosis was of well-differentiated adenocarcinoma with supraclavicular lymph node metastasis (pT3 pN3 pM1 pStage IV). Two months after the operation, the patient was diagnosed with recurrence in the neck lymph nodes and underwent chemotherapy; however, she died. A 66-year-old man with early-stage esophageal cancer underwent subtotal esophagectomy. A superficial early cancerous lesion was seen over BE. The postoperative pathological diagnosis was of well-differentiated adenocarcinoma without lymph node metastasis (pT1a pN0 pM0 pStage 0). The patient was found to be alive and recurrence-free 3 months after the operation.
BEAC might show good prognosis if detected and treated early. Extremely LSBE is associated with a high incidence of BEAC; therefore, early detection and treatment with close surveillance is essential.
巴雷特食管（BE）的特征是食管下段黏膜存在柱状上皮，而食管下段黏膜原本由复层鳞状上皮组成。胃食管反流病会导致BE和BE腺癌（BEAC）；此外，BEAC的发病率正在上升，尤其是在发达国家。长段BE（LSBE）具有特别高的致癌潜力，需要进行治疗、监测和预防。
在此，我们报告3例起源于长度超过15 cm的LSBE的BEAC病例。所有3例患者均因BEAC诊断而接受了手术。一名66岁的晚期食管癌男性患者接受了新辅助化疗，随后进行了食管次全切除术。术后病理诊断为低分化腺癌伴淋巴结转移（根据国际癌症控制联盟第8版TNM分类为pT3 pN3 pM0 pStage III）。术后两年，该患者被诊断为腹腔动脉周围复发并接受了化疗。一名83岁的晚期食管癌女性患者接受了食管次全切除术。术后病理诊断为高分化腺癌伴锁骨上淋巴结转移（pT3 pN3 pM1 pStage IV）。术后两个月，该患者被诊断为颈部淋巴结复发并接受了化疗；然而，她去世了。一名66岁的早期食管癌男性患者接受了食管次全切除术。在BE上可见浅表早期癌性病变。术后病理诊断为高分化腺癌，无淋巴结转移（pT1a pN0 pM0 pStage 0）。术后3个月，该患者存活且无复发。
如果早期发现并治疗，BEAC可能预后良好。极长段LSBE与BEAC的高发病率相关；因此，早期发现并密切监测下进行治疗至关重要。
