Hirota T, Nishimaki T, Suzuki T, Komukai S, Kuwabara S, Aizawa K, Hatakeyama K
First Department of Surgery, Niigata University School of Medicine, Japan.
Surg Today. 1998;28(11):1160-2. doi: 10.1007/s005950050304.
We report herein the rare case of a 65-year-old man found to have esophageal intramural metastasis from cancer of the gastric cardia. Endoscopic examination initially revealed an infiltrating ulcerative tumor of the gastric cardia involving the esophagogastric junction, as well as a submucosal tumor of the lower esophagus. A total thoracic esophagogastrectomy with lower mediastinal lymphadenectomy was performed, and the resected specimen demonstrated that both the cardia and esophageal tumors were adenocarcinomas with the same cellular differentiation. As lymphatic invasion and metastases to the paracardial and mediastinal lymph nodes were observed, the esophageal submucosal tumor was considered to be an intramural metastasis from the carcinoma of the gastric cardia resulting from extensive lymphatic spread. The patient died of recurrent disease 9 months after the resection. This case report serves to demonstrate that intramural metastasis may be a local indicator of the systemic spread of disease in patients with gastric carcinoma, as it is in esophageal carcinoma.
我们在此报告一例罕见病例，一名65岁男性被发现患有来自胃贲门癌的食管壁内转移。内镜检查最初显示胃贲门有浸润性溃疡性肿瘤累及食管胃交界部，以及食管下段的黏膜下肿瘤。实施了全胸段食管胃切除术及下纵隔淋巴结清扫术，切除标本显示贲门和食管肿瘤均为具有相同细胞分化的腺癌。由于观察到有淋巴侵犯以及向贲门旁和纵隔淋巴结转移，食管黏膜下肿瘤被认为是胃贲门癌因广泛淋巴扩散导致的壁内转移。患者在切除术后9个月死于复发疾病。本病例报告旨在证明壁内转移可能是胃癌患者疾病全身扩散的一个局部指标，如同在食管癌中一样。
