Ito Mamoru, Dobashi Akira, Komori Moe, Sugimura Shun, Aizawa Daisuke, Takahashi Keita, Tanishima Yuichiro, Sumiyama Kazuki
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan.
Department of Gastroenterology and Hepatology The Jikei University School of Medicine Tokyo Japan.
DEN Open. 2023 Feb 21;3(1):e214. doi: 10.1002/deo2.214. eCollection 2023 Apr.
Esophageal adenocarcinoma derived from the ectopic gastric mucosa of the cervical esophagus is very rare. Little is known about the efficacy of endoscopic treatment of these superficial lesions. Herein, we report the first case of lymph node metastasis after endoscopic submucosal dissection of a lesion with invasion into the muscularis mucosa. A 46-year-old man underwent esophagogastroduodenoscopy during a health checkup. Endoscopy revealed a 10-mm-sized nodular and a 5-mm-sized depressed lesion within the ectopic gastric mucosa of the cervical esophagus. The biopsy specimen confirmed the presence of adenocarcinoma. The entire ectopic gastric mucosa was resected by endoscopic submucosal dissection, and pathological examination showed invasion of the muscularis mucosa. A follow-up computed tomography scan revealed lymph node metastasis 12 months post-treatment. The patient underwent surgical mediastinal lymphadenectomy. The patient has been regularly followed up with a computed tomography scan and endoscopy for 2 years post-surgery with no evidence of recurrence. Close follow-up or additional treatment after endoscopic submucosal dissection should be considered and discussed with the patient if invasion into the muscularis mucosa is observed on pathological examination.
源自颈段食管异位胃黏膜的食管腺癌非常罕见。对于这些浅表病变的内镜治疗效果知之甚少。在此，我们报告首例经内镜黏膜下剥离术治疗侵犯黏膜肌层的病变后发生淋巴结转移的病例。一名46岁男性在健康体检期间接受了食管胃十二指肠镜检查。内镜检查发现颈段食管异位胃黏膜内有一个10毫米大小的结节状病变和一个5毫米大小的凹陷性病变。活检标本证实为腺癌。通过内镜黏膜下剥离术切除了整个异位胃黏膜，病理检查显示侵犯了黏膜肌层。随访计算机断层扫描显示治疗后12个月出现淋巴结转移。患者接受了手术纵隔淋巴结清扫术。术后2年，患者定期接受计算机断层扫描和内镜检查随访，无复发迹象。如果病理检查发现侵犯黏膜肌层，应考虑在内镜黏膜下剥离术后进行密切随访或额外治疗，并与患者进行讨论。
