PMC8616704_01
Primary esophageal carcinoma in the lower thoracic esophagus. (a) Gross appearance of the esophageal carcinoma. A 35 x 30 mm of ulcerative tumor in the lower third of the thoracic esophagus was seen. (b) Histologic finding. Hematoxylin and eosin (HE) staining showed well-differentiated squamous cell carcinoma. (c) High magnification view. Well-differentiated carcinoma with large squamous pearls was seen.
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Macroscopic analysis of the resected specimens revealed an ulcerative tumor in the lower third of the thoracic esophagus (Figure 1(a)). The pathological examination showed the primary tumor consisted of well-differentiated SCC, invading the adventitia (Figures 1(b) and 1(c)).
Axial and coronal images of multidetector row CT scan. (a) The preoperative CT scan showed swollen para-aortic and mesenteric lymph nodes. These were diagnosed with lymphatic metastases from the primary esophageal carcinoma. (b, c) CT scans revealed a single occlusive point. The circumferential tumor let us take into consideration an esophageal cancer metastasis as a potential cause of the obstruction. The arrows show a thickened small intestine wall, thus showing the metastatic site.
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The extent of lymphadenopathy suggested lymphatic metastases from the primary esophageal carcinoma (Figure 2(a)). Additionally, small intestinal metastasis from the esophageal carcinoma was considered to be the cause of the small bowel obstruction, as the CT scans showed a tumor in the small bowel, where circumferential mural thickening in the jejunum was visible (Figures 2(b) and 2(c)).
Metastatic tumors from esophageal carcinoma in the small intestine. (a) Gross finding at surgery. The metastatic tumor obstructed the small intestine. (b) Gross appearance of the resected small intestine. Two metastatic tumors were present. The left specimen showed circumferential stenosis in the jejunum. (c) Histologic finding of the metastatic tumor in the jejunum. HE stains showed moderately differentiated squamous cell carcinoma. (d) High magnification view. Moderately differentiated squamous cell carcinoma growing in a trabecular pattern. The pathological features were consistent with the diagnosis of esophageal cancer metastasis.
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Treitz (Figure 3(b)). The proximal lesion was only a small nodule in the intestinal wall, whereas the distal tumor was larger, creating a transition point, which was considered to be the obstruction point (Figures 3(a) and 3(b)). The resected specimens were both pathologically diagnosed with moderately differentiated SCC and confirmed to originate from the esophageal carcinoma (Figures 3(c) and 3(d)).