Mafune K, Tanaka Y, Ma Y Y, Takubo K
Department of Surgery, Saitama Cancer Center, Japan.
J Surg Oncol. 1995 Dec;60(4):277-81. doi: 10.1002/jso.2930600412.
A case of synchronous squamous cell carcinoma of the esophagus and adenocarcinoma of the ampulla of Vater after previous gastrectomy is presented. The coexistence of these two lesions has never been reported in the English literature. We performed a subtotal esophagectomy, total residual gastrectomy, and pancreaticoduodenectomy with lymph node dissection in a one-stage procedure. An operation of this magnitude could be safely performed with attention to meticulous surgical technique and intensive postoperative care. Histological examination of the ampulla lesion showed adenocarcinoma with Paneth-cell differentiation. This is a rare lesion, and a review of the literature revealed only one other case. Neoplastic Paneth cells were also found in lymph node metastasis that originated from the ampulla tumor. This case confirms that cells with Paneth-cell differentiation can be a significant component in invasive carcinoma.
本文报告1例既往胃切除术后发生食管同步鳞状细胞癌和壶腹腺癌的病例。英文文献中从未报道过这两种病变并存的情况。我们采用一期手术行次全食管切除术、全残胃切除术及胰十二指肠切除术并清扫淋巴结。通过注重精细的手术技巧和加强术后护理，可安全地实施如此大型的手术。壶腹病变的组织学检查显示为具有潘氏细胞分化的腺癌。这是一种罕见病变，文献复习仅发现另外1例。在源于壶腹肿瘤的淋巴结转移灶中也发现了肿瘤性潘氏细胞。该病例证实具有潘氏细胞分化的细胞可成为浸润性癌的重要组成部分。
