BACKGROUND Esophageal neuroendocrine carcinoma(NEC),a rare and aggressive malignancy with a poor prognosis,is often diagnosed at an advanced stage.The optimal treatment strategy for locally advanced and recurrent esop...BACKGROUND Esophageal neuroendocrine carcinoma(NEC),a rare and aggressive malignancy with a poor prognosis,is often diagnosed at an advanced stage.The optimal treatment strategy for locally advanced and recurrent esophageal NEC remains unclear,and conversion surgery has only been reported for a few cases.Herein,we present the case of a 66-year-old male with locally advanced esophageal NEC initially diagnosed as squamous cell carcinoma.CASE SUMMARY The patient underwent induction chemotherapy with docetaxel,cisplatin,and 5-fluorouracil,followed by conversion surgery,including subtotal esophagectomy,three-field lymph node dissection,and distal pancreatectomy with splenectomy,due to infiltration of the pancreas by the No.11p lymph node.Postoperative pathological findings revealed a large cell-type NEC without a squamous cell carcinoma component,suspected to be a mixed neuroendocrine/non-neuroendocrine neoplasm.Hepatic metastasis was diagnosed within one month of surgery.Despite the administration of four courses of irinotecan+cisplatin chemotherapy,the treatment effect was considered a‘progressive disease’.After a multidisciplinary discussion,the patient underwent partial liver resection,followed by second-line chemotherapy with amrubicin.The patient achieved three-year survival with no new recurrence.CONCLUSION This case highlights the potential of multimodal treatment for long-term survival in advanced esophageal NEC.展开更多
We herein report a case of bronchial bleeding afterradical esophagectomy that was treated with lobectomy.A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal ca...We herein report a case of bronchial bleeding afterradical esophagectomy that was treated with lobectomy.A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis.After the esophagectomy,bilateral vocal cord paralysis was observed,and the patient suffered from repeated episodes of aspiration pneumonia.Bronchoscopy revealed hemosputum in the right middle lobe bronchus,and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus.Although bronchial arterial embolization was performed twice to control the recurrent hemoptysis,the procedures were unsuccessful.Right middle lobectomy was therefore performed via video-assisted thoracic surgery.Engorged bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected specimen.The patient recovered uneventfully and was discharged on postoperative day 14.展开更多
Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal in...Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal injury caused by drinking a cup of hot coffee six months earlier was referred to our hospital. The hot coffee was consumed in a single gulp at a party. Although the patient had been treated conservatively at another hospital, his symptoms of dysphagia gradually worsened after discharge. An upper gastrointestinal endoscopy and computed tomography revealed a pinhole like area of stricture located 19 cm distally from the incisors to the esophagogastric junction, as well as circumferential stenosis with notable wall thickness at the same site. The patient underwent a thoracoscopic esophageal resection with reconstruction using ileocolon interposition. The pathological findings revealed wall thickening along the entire length of the esophagus, with massive fibrosis extending to the muscularis propria and adventitia at almost all levels. Treatment with balloon dilation for long areas of stricture is generally difficult, and stent placement in patients with benign esophageal stricture, particularly young patients, is not yet widely accepted due to the incidence of late adverse events. Considering the curability and qualityof-life associated with a long expected prognosis, we determined that surgery was the best treatment option for this young patient. In this case, we decided to perform an esophagectomy and reconstruction with ileocolon interposition in order to preserve the reservoir function of the stomach and to avoid any problems related to the reflux of gastric contents. In conclusion, resection of the esophagus is a treatment option in patients with benign esophageal injury, especially in cases involving young patients with refractory esophageal stricture. In addition, ileocolon interposition may help to improve the quality-of-life of patients.展开更多
文摘BACKGROUND Esophageal neuroendocrine carcinoma(NEC),a rare and aggressive malignancy with a poor prognosis,is often diagnosed at an advanced stage.The optimal treatment strategy for locally advanced and recurrent esophageal NEC remains unclear,and conversion surgery has only been reported for a few cases.Herein,we present the case of a 66-year-old male with locally advanced esophageal NEC initially diagnosed as squamous cell carcinoma.CASE SUMMARY The patient underwent induction chemotherapy with docetaxel,cisplatin,and 5-fluorouracil,followed by conversion surgery,including subtotal esophagectomy,three-field lymph node dissection,and distal pancreatectomy with splenectomy,due to infiltration of the pancreas by the No.11p lymph node.Postoperative pathological findings revealed a large cell-type NEC without a squamous cell carcinoma component,suspected to be a mixed neuroendocrine/non-neuroendocrine neoplasm.Hepatic metastasis was diagnosed within one month of surgery.Despite the administration of four courses of irinotecan+cisplatin chemotherapy,the treatment effect was considered a‘progressive disease’.After a multidisciplinary discussion,the patient underwent partial liver resection,followed by second-line chemotherapy with amrubicin.The patient achieved three-year survival with no new recurrence.CONCLUSION This case highlights the potential of multimodal treatment for long-term survival in advanced esophageal NEC.
文摘We herein report a case of bronchial bleeding afterradical esophagectomy that was treated with lobectomy.A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis.After the esophagectomy,bilateral vocal cord paralysis was observed,and the patient suffered from repeated episodes of aspiration pneumonia.Bronchoscopy revealed hemosputum in the right middle lobe bronchus,and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus.Although bronchial arterial embolization was performed twice to control the recurrent hemoptysis,the procedures were unsuccessful.Right middle lobectomy was therefore performed via video-assisted thoracic surgery.Engorged bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected specimen.The patient recovered uneventfully and was discharged on postoperative day 14.
文摘Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal injury caused by drinking a cup of hot coffee six months earlier was referred to our hospital. The hot coffee was consumed in a single gulp at a party. Although the patient had been treated conservatively at another hospital, his symptoms of dysphagia gradually worsened after discharge. An upper gastrointestinal endoscopy and computed tomography revealed a pinhole like area of stricture located 19 cm distally from the incisors to the esophagogastric junction, as well as circumferential stenosis with notable wall thickness at the same site. The patient underwent a thoracoscopic esophageal resection with reconstruction using ileocolon interposition. The pathological findings revealed wall thickening along the entire length of the esophagus, with massive fibrosis extending to the muscularis propria and adventitia at almost all levels. Treatment with balloon dilation for long areas of stricture is generally difficult, and stent placement in patients with benign esophageal stricture, particularly young patients, is not yet widely accepted due to the incidence of late adverse events. Considering the curability and qualityof-life associated with a long expected prognosis, we determined that surgery was the best treatment option for this young patient. In this case, we decided to perform an esophagectomy and reconstruction with ileocolon interposition in order to preserve the reservoir function of the stomach and to avoid any problems related to the reflux of gastric contents. In conclusion, resection of the esophagus is a treatment option in patients with benign esophageal injury, especially in cases involving young patients with refractory esophageal stricture. In addition, ileocolon interposition may help to improve the quality-of-life of patients.
