Akira Kajiwara, Nishiyama Takahiro, Ozeki Ryota, Yamada Junya, Hiramatsu Takeshi
Gastroenterology, Ichinomiya Municipal Hospital, Ichinomiya, JPN.
Hematology, Ichinomiya Municipal Hospital, Ichinomiya, JPN.
Cureus. 2025 Feb 7;17(2):e78717. doi: 10.7759/cureus.78717. eCollection 2025 Feb.
A 66-year-old man presented with dysphagia and a cervical mass. Initial imaging showed an enlarged left cervical lymph node but no intra-abdominal metastasis. Esophagogastroduodenoscopy and histopathologic evaluation of the primary lesion and cervical lymph node led to the diagnosis of esophageal squamous cell carcinoma (ESCC) with cervical lymph node metastasis. Notably, the serum anti-p53 antibody level was elevated to 191.2 U/mL (normal range: ≤1.3 U/mL; measurement method: chemiluminescent enzyme immunoassay). The patient began chemoradiotherapy (CRT) with cisplatin and 5-fluorouracil, leading to the substantial shrinkage of the primary esophageal tumor. However, within weeks, he developed peritoneal dissemination and carcinomatous peritonitis, ultimately passing away. The autopsy revealed widespread peritoneal dissemination, mesenteric obstruction, and systemic lymph node metastases. Peritoneal dissemination and metastasis to the skin and intestine of ESCC are relatively rare. This case illustrates the potential prognostic significance of high serum anti-p53 antibody levels in ESCC, suggesting a link to aggressive disease progression and early metastatic spread. Elevated anti-p53 levels, correlating with strong p53 tumor immunoreactivity, may indicate a poor prognosis in ESCC, though further investigation is needed. This case highlights the need for close monitoring of ESCC patients with elevated serum anti-p53 antibodies, which could serve as markers for metastatic risk and therapeutic responsiveness, warranting further study in ESCC management strategies.
一名66岁男性因吞咽困难和颈部肿块就诊。初始影像学检查显示左侧颈部淋巴结肿大，但无腹腔内转移。对原发灶和颈部淋巴结进行食管胃十二指肠镜检查及组织病理学评估后，诊断为食管鳞状细胞癌（ESCC）伴颈部淋巴结转移。值得注意的是，血清抗p53抗体水平升高至191.2 U/mL（正常范围：≤1.3 U/mL；检测方法：化学发光酶免疫分析）。患者开始接受顺铂和5-氟尿嘧啶的放化疗（CRT），食管原发肿瘤显著缩小。然而，数周内，他出现了腹膜播散和癌性腹膜炎，最终死亡。尸检显示广泛的腹膜播散、肠系膜梗阻和全身淋巴结转移。ESCC的腹膜播散以及皮肤和肠道转移相对少见。该病例说明了ESCC患者血清抗p53抗体水平升高的潜在预后意义，提示其与侵袭性疾病进展和早期转移扩散有关。抗p53水平升高与强烈的p53肿瘤免疫反应性相关，可能表明ESCC预后不良，不过仍需进一步研究。该病例强调了对血清抗p53抗体升高的ESCC患者进行密切监测的必要性，这可作为转移风险和治疗反应性的标志物，值得在ESCC管理策略中进一步研究。
