Suzuki S, Matsushima S, Ninomiya J, Shibuya T, Shoji T, Yamada N
Second Department of Surgery, Nippon Medical School, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Dec;41(12):2418-23.
We reported a rare case of subtotal esophagectomy for esophageal basaloid carcinoma after mitral valve replacement. Up to present, only this case had been printed in Japan. A 51-year-old male who had been performed MVR for mitral stenosis at the 44 complained of dysphagia. On esophageal X-ray and esophagoscopic findings showed round, irregular, and stenotic lesion (type-3) in the middle thoracic esophagus. We performed subtotal esophagectomy, esophagogastrostomy through the posterior mediastinal pathway and lymph node dissection (R2). Despite normal cardiac function before operation, the patient followed lung edema and perioperative measurement of Extra Vascular Lung Water Index (EVLWI) was stable within high level. On microscopic inspection, we revealed lots of basophilic basal cells mainly occupied submucosal layer coexisted with pseudoglandular formation and poorly differentiated squamous cell carcinoma. And the tumor cells strongly invaded into the lymph ducts and blood vessels. We need more detailed exploration for more cases about factors causing poor prognosis.
我们报告了一例二尖瓣置换术后因食管基底样癌行食管次全切除术的罕见病例。截至目前，日本仅报道过这一例。一名51岁男性，44岁时因二尖瓣狭窄接受了二尖瓣置换术，现出现吞咽困难。食管X线和食管镜检查发现中胸段食管有圆形、不规则形狭窄病变（3型）。我们进行了食管次全切除术，经后纵隔途径行食管胃吻合术及淋巴结清扫（R2）。尽管术前心功能正常，但患者出现了肺水肿，围手术期血管外肺水指数（EVLWI）在高水平内保持稳定。显微镜检查显示，大量嗜碱性基底细胞主要占据黏膜下层，伴有假腺管形成和低分化鳞状细胞癌。肿瘤细胞强烈侵犯淋巴管和血管。我们需要对更多病例进行更详细的探索，以了解导致预后不良的因素。
