PMC7708758_01
(A) Endoscopic image showing a slightly elevated lesion (0-IIa type), occupying one-fourth of the circumference of the lower thoracic esophagus. (B) Endoscopic ultrasonography showing hypoechogenic destruction of the interface between the second and third sonographic layers.
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Endoscopy and endoscopic ultrasonography of the esophagus showed a 0-IIa type tumor with submucosal involvement in the lower thoracic esophagus (Fig. 1).
Preoperative abdominal CT showing (A) no findings of liver metastasis and (B) no evidence of pancreatic head tumor and lymph nodes swelling.
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Computed tomography (CT) from the neck to pelvis, which was taken 24 days befor surgery, did not reveal lymph node involvement, distant metastasis or other concomitant tumors (Fig. 2).
Diffusion weighted magnetic resonance imaging of the brain showing multiple high-intensity areas in both (A) cerebral hemispheres and (B) the cerebellum.
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Although magnetic resonance angiography showed no overt occlusion of head and neck arteries, magnetic resonance imaging with diffusion-weighted image revealed multiple high-intensity areas in both cerebral hemispheres and the cerebellum (Fig. 3).
On postoperative day 46, abdominal CT showing findings of (A) multiple liver metastases and (B) pancreatic head tumor with regional lymph nodes swelling.
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The contrast-enhanced CT showed a pancreatic head tumor with multiple liver metastases (Fig. 4).
Histological examination of (A) the pancreas (x100), (B) para-pancreatic lymph node (x100), (C) liver (x20) and (D), right lung (x100), showing various morphological features, including glandular, papillary, solid structures and signet ring cells with abundant mucin.
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The pancreatic adenocarcinoma, histologically, has various morphological features, including glandular, papillary, solid structures and signet ring cells with abundant mucin (Fig. 5A). Multiple cancerous lesions in para-pancreatic lymph nodes, liver, both lungs, peritoneum and a right adrenal gland had similar pathological features (Fig. 5B-D), indicating they were metastases from pancreatic cancer.