PMC3913426_01
Pretreatment endoscopic examination, CT scan, FDG-PET and post-treatment endoscopic examination. A tumor was found in the middle thoracic esophagus (a). CT scans revealed possible invasion of the aorta (b) and multiple lymph node metastases. FDG-PET also suggested the spread of tumors (open arrow) and multiple lymph node metastases (white arrows) (c). Post-treatment endoscopy showed a marked reduction in the size of the tumor, while residual carcinoma cells were detected in a biopsy specimen (white arrows) (d).
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RJT117F1
August 2012. An endoscopic examination revealed middle thoracic ESCC (Fig. 1). Computed tomography (CT) scans showed possible invasion of the aorta and multiple lymph node metastases (T4bN3M1 stage4) (Fig. 1). Although an endoscopic biopsy specimen was positive for cancer (Fig. 1), post-treatment CT showed no invasion of the aorta.
Colonoscopy and histology of a biopsy specimen. A small elevated lesion was found at the site of the splenic flexure (white arrows) (a and b). Hematoxylin-eosin staining and CK14 staining (c and d).
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RJT117F2
Preoperative colonoscopy revealed a 1.0-cm submucosal tumor at the splenic flexure, and biopsy results indicated possible metastasis from primary ESCC (Fig. 2). CK14 and p63, and negative for CK20 and Caudal type homeobox 2 (CDX2) (Fig. 2). Colonic metastasis was not detected by FDG-PET before or after chemoradiotherapy.
Macroscopic and microscopic findings of resected esophagus and colon. A flat tumor was found in the esophagus (white arrows) (a). A 1.0-cm submucosalcolonic tumor was excised (white arrows) (b). Remnant viable cells were observed in the esophagus (white arrows) and lymph nodes (c). Colonic metastasis was located in the submucosa and slight invasion of the muscularispropria was observed (white arrows) (d).
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RJT117F3
Local excision of the colonic submucosal tumor was also performed (Fig. 3). ESCC and remnant viable carcinoma cells were found in the primary site of the esophagus and lymph nodes (Fig. 3). Even though the patient was discharged 18 days after surgery without any complications, he died on the 72nd postoperative day due to multiple bone metastases and pleural dissemination.