Zhang Qun-Xian, Guo Qiang, Liu Hua, Zhou Jun, Guo Jia-Long, Zhang Jun
Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
Front Oncol. 2025 Jun 26;15:1589929. doi: 10.3389/fonc.2025.1589929. eCollection 2025.
Esophageal squamous cell carcinoma (ESCC) is among the most common malignant tumors. Robot-assisted surgery using the cervical and thoracoabdominal incisions is a viable treatment option for ESCC. This case report presents a rare instance of ESCC complicated by hepato-gastric schwannoma, offering clinical insights and treatment strategies. A 69-year-old patient diagnosed with ESCC via gastroscopy was admitted without complaints of dysphagia. Gastroscopy revealed swollen erosions approximately 32-38 cm from the incisors. Pathology confirmed high-grade intraepithelial neoplasia and squamous cell carcinoma (SCC) of the esophageal squamous epithelium. Endoscopic ultrasonography revealed a lesion with moderate to low echogenicity, indicating local involvement of the muscularis propria. An enhanced upper abdominal computed tomography (CT) scan showed a 3.3 × 2.6 cm mass in the hepatogastric space, accompanied by mildly enlarged lymph nodes-the largest measuring 0.8 cm-which suggested possible metastasis. After a comprehensive evaluation, the patient underwent robot-assisted thoracoscopic partial esophagectomy, intrathoracic esophagogastric anastomosis, thoracoscopic adhesiolysis, and mediastinal lymphadenectomy under general anesthesia. Postoperative pathology showed a poorly to moderately differentiated ESCC (pTNM) measuring 3 cm × 2.7 cm × 0.2 cm, invading the lamina propria without vascular or neural invasion, and there is a schwannoma with a diameter of 3.5cm. No cancer was found at the gastric margin or anastomotic stump. Lymph nodes-including right and left recurrent laryngeal, subcarinal, left gastric, paracardiac, upper paraesophageal, and hepatogastric-were free of metastasis. The patient received postoperative supportive care, including antibiotics, acid suppression, mucolytics, antispasmodics, intravenous nutrition, and albumin supplementation. On postoperative day 7, iodine water angiography revealed no significant abnormalities at the anastomosis, permitting the reintroduction of a liquid diet. The patient was discharged in stable condition on postoperative day 10. No evidence of progression or recurrence has been observed during the follow-up. This report aims to inform clinical practice with insights into the management of rare coexisting pathologies.
食管鳞状细胞癌（ESCC）是最常见的恶性肿瘤之一。采用颈部和胸腹联合切口的机器人辅助手术是ESCC的一种可行治疗选择。本病例报告呈现了一例罕见的ESCC合并肝胃神经鞘瘤的病例，提供了临床见解和治疗策略。一名69岁经胃镜诊断为ESCC的患者入院时无吞咽困难主诉。胃镜显示距门齿约32 - 38 cm处有肿胀糜烂。病理证实为食管鳞状上皮高级别上皮内瘤变和鳞状细胞癌（SCC）。内镜超声显示一个中等至低回声的病变，提示固有肌层局部受累。上腹部增强计算机断层扫描（CT）显示肝胃间隙有一个3.3×2.6 cm的肿块，伴有轻度肿大的淋巴结——最大直径为0.8 cm——提示可能转移。综合评估后，患者在全身麻醉下接受了机器人辅助胸腔镜部分食管切除术、胸内食管胃吻合术、胸腔镜粘连松解术和纵隔淋巴结清扫术。术后病理显示为低分化至中分化的ESCC（pTNM），大小为3 cm×2.7 cm×0.2 cm，侵犯固有层，无血管或神经侵犯，还有一个直径为3.5 cm的神经鞘瘤。胃切缘和吻合残端未发现癌细胞。包括左右喉返神经、隆突下、左胃、贲门旁、食管上段旁和肝胃淋巴结均无转移。患者接受了术后支持治疗，包括抗生素、抑酸、黏液溶解剂、解痉剂、静脉营养和补充白蛋白。术后第7天，碘水血管造影显示吻合口无明显异常，允许恢复流食。患者术后第10天病情稳定出院。随访期间未观察到进展或复发迹象。本报告旨在通过对罕见并存病理情况的管理见解为临床实践提供参考。
