Kuwayama Naoki, Hoshino Isamu, Gunji Hisashi, Kurosaki Takeshi, Tonooka Toru, Soda Hiroaki, Sonoda Itaru, Eto Ryotaro, Takiguchi Nobuhiro, Nabeya Yoshihiro, Itami Makiko, Takayama Wataru
Division of Gastroenterological Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
Division of Surgical Pathology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
Surg Case Rep. 2021 Jul 15;7(1):166. doi: 10.1186/s40792-021-01252-1.
Although there are many studies on primary esophageal adenocarcinoma arising from Barrett's esophagus or ectopic gastric mucosa, reports on adenocarcinoma arising from esophageal cardiac glands are extremely rare. Herein, we report a case of mid-thoracic cancer antigen 19-9 (CA 19-9)-producing primary esophageal adenocarcinoma, which presumably originated from the cardiac glands.
A 74-year-old man was referred to our department with advanced esophageal cancer, which initially presented with dyspepsia. Serum levels of cancer antigen 19-9 (CA 19-9) were elevated (724.89 U/ml). Upper gastrointestinal endoscopy revealed a type 2 tumor on the posterior wall of the mid-thoracic esophagus approximately 29-32 cm from the incisor. Mucosal biopsy was consistent with a diagnosis of adenocarcinoma. Contrast-enhanced computed tomography showed a circumferential wall thickening in the mid-thoracic esophagus without enlarged lymph nodes or distant metastasis. Positron emission tomography-computed tomography showed accumulation in the primary tumor, but no evidence of lymph node or distant metastasis. According to these findings, the adenocarcinoma was staged as cT3N0M0, thereby, requiring subtotal esophagectomy with lymph node dissection. Postoperative course was uneventful. Histopathologic analysis revealed a 50 × 40 mm moderately differentiated adenocarcinoma with invasion to the thoracic duct and lymph node metastasis at #108(1/4), #109R(1/3), and #109L(1/3). After surgery, the stage was revised to moderately differentiated pT4apN2pM0 (pStage III). Immunostaining revealed expression of CA19-9 and suggested esophageal cardiac gland origin of the tumor. Three months after the surgery, the patient showed no recurrence and is undergoing outpatient observation.
We experienced a case of mid-thoracic CA19-9-producing primary esophageal adenocarcinoma, which was presumed to have originated in the esophageal cardiac glands. Due to the scarcity of studies regarding this condition, specific management needs to be further clarified.
尽管有许多关于起源于巴雷特食管或异位胃黏膜的原发性食管腺癌的研究，但关于起源于食管贲门腺的腺癌的报道极为罕见。在此，我们报告一例产生胸中段癌抗原19-9（CA 19-9）的原发性食管腺癌病例，推测其起源于贲门腺。
一名74岁男性因晚期食管癌被转诊至我科，最初表现为消化不良。癌抗原19-9（CA 19-9）血清水平升高（724.89 U/ml）。上消化道内镜检查显示，在距门齿约29 - 32 cm处的胸中段食管后壁有一2型肿瘤。黏膜活检确诊为腺癌。增强计算机断层扫描显示胸中段食管壁环形增厚，无淋巴结肿大或远处转移。正电子发射断层扫描 - 计算机断层扫描显示原发肿瘤有放射性浓聚，但无淋巴结或远处转移迹象。根据这些发现，该腺癌分期为cT3N0M0，因此需要行食管次全切除术加淋巴结清扫术。术后过程顺利。组织病理学分析显示为一个50×40 mm的中分化腺癌，侵犯胸导管，且在#108（1/4）、#109R（1/3）和#109L（1/3）处有淋巴结转移。手术后，分期修订为中分化pT4apN2pM0（p分期III期）。免疫组化显示CA19-9表达，提示肿瘤起源于食管贲门腺。手术后三个月，患者无复发，正在门诊观察。
我们遇到一例产生胸中段CA19-9的原发性食管腺癌病例，推测其起源于食管贲门腺。由于关于这种情况的研究较少，具体的治疗方法需要进一步明确。
