PMC6041422_01
a) A marked thickening of the middle intra-thoracic oesophageal wall (red arrow). b) A bilateral infiltration and a mass (blue arrow), 10 x 10 mm in size, in the right S9 lesion.
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A computed tomography (CT) scan of the chest showed marked thickening of the middle intrathoracic oesophageal wall, bilateral infiltration, and a mass, 10 x 10 mm in size, in the right segment 9 (S9) lesion (Fig. 1).
A contrast CT of the abdomen showing ascites (a), free air (b; red arrow), and irregular thickness of the small intestinal walls (c; blue arrows).
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A contrast CT scan of the abdomen showed ascites, free air, irregular thickness of the small intestinal walls, and mesenteric lymphadenopathy (Fig. 2).
Intraoperative findings showed the perforated surface of the small intestine ulcer located 110 cm and localised ulcer 80 cm distal to the ligament of Treitz.
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Intraoperative findings showed that a non-perforated ulcer with a submucosal nodule approximately 80 cm distal from the ligament of Treitz and a perforated ulcer approximately 110 cm distal from the ligament of Treitz (Fig. 3).
The pathological findings of the resected small intestine revealing the ulcers with squamous cell carcinoma (a: Hematoxylin and eosin (HE) stain x40 magnification. b: HE stain x100 magnification. c: HE stain x200 magnification. d: P63 immunostaining x100 magnification. e: Cytokeratin 5/6 immunostaining x100 magnification.) The pathological results of the esophageal biopsy showing a moderately differentiated squamous cell carcinoma (f: HE stain x200 magnification.).
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Thus the pathological findings of the resected small intestine revealed ulcers with squamous cell carcinoma, which suggests the primary site of carcinoma is different since the other sites of the small intestine did not have any findings of malignancy and primary squamous cell carcinoma of the small intestine is extremely rare. (Fig. 4a-e). The pathological results of the biopsy revealed a moderately differentiated squamous cell carcinoma of the oesophagus as well (Fig. 4d).
An upper gastrointestinal endoscopy showing ulcerative and localised type of oesophageal tumour 28 cm from the incisors.
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On postoperative day 7, upper gastrointestinal endoscopy was performed, and ulcerative and localised type of oesophageal tumour as the macroscopic classification was observed 28 cm from the incisors (Fig. 5).