PMC7154264_01
First recurrence at the esophago-jejunal pouch anastomosis (A-C), and second recurrence at the anastomosis line within the J-pouch (D-F). A Macroscopic appearance of the irregularly elevated mass at the esophago-jejunal pouch anastomosis at the first recurrence B The trans-hiatal resection of the esophago-jejunal anastomosis reveals a 2 x 2 cm circular elevated lesion with irregular borders. C Histology of the tumor. A well-differentiated adenocarcinoma with focal papillary growth is present at the site of squamous and columnar epithelial junction. D, E Second recurrence at 2 sites of the anastomosis line within the J-pouch at 14 months after surgery. F The resection sample reveals a 2 x 2 cm circular elevated lesion with irregular borders and a smaller 1 x 1.5 cm elevated lesion. Both tumors are histologically well-differentiated adenocarcinomas with papillary structures, which resembles the previous recurrent tumor. Red arrows represent suture lines, yellow arrows represent recurrence tumors.
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F1
A gastrointestinal endoscopy revealed an irregularly elevated mass at the esophago-jejunal pouch anastomosis (Fig. 1A and 2A), and the biopsy of the lesion confirmed an adenocarcinoma. The patient underwent the resection of the esophago-jejunal anastomosis using a trans-hiatal approach (Fig. 1B). Pathological examination of the resected specimen revealed a well-differentiated tubular adenocarcinoma with focal papillary structures (Fig. 1C). In 2008, 14 months after the second surgery, the patient was rediagnosed as having a tumor recurrence at 2 sites of the suture line within the J-pouch (Fig. 1D, E, and 2B) and he again underwent a J-pouch resection with a jejunal R-Y reconstruction. The resected sample contained a circularly elevated lesion, measuring 2 x 2 cm, with irregular borders and a smaller elevated lesion, measuring 1 x 1.5 cm (Fig. 1F).
Schematic diagram of the recurrence site. The site of recurrence is shown as red circles for the first (A), second (B), third (C), and fourth (D) recurrence.
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F2
A gastrointestinal endoscopy revealed an irregularly elevated mass at the esophago-jejunal pouch anastomosis (Fig. 1A and 2A), and the biopsy of the lesion confirmed an adenocarcinoma. In 2008, 14 months after the second surgery, the patient was rediagnosed as having a tumor recurrence at 2 sites of the suture line within the J-pouch (Fig. 1D, E, and 2B) and he again underwent a J-pouch resection with a jejunal R-Y reconstruction. Nine months after the third operation, a mucosal lesion at the posterior wall of the esophago-jejunal anastomosis was found in the patient (Fig. 2C and 3A), and he underwent endoscopic submucosal dissection. The patient underwent a jejunal resection, partial resection of the liver and transverse and descending colons with a jejunal R-Y reconstruction (Fig. 2D and 3C).
Third recurrence at the esophago-jejunal anastomosis (A, B), and fourth recurrence in the close vicinity of the jejunum and Y loop (C, D). A The patient was diagnosed with a mucosal lesion at the posterior wall of the esophago-jejunal anastomosis for which the patient underwent endoscopic submucosal dissection. The resection sample reveals a 10 x 5 mm circular elevated lesion with irregular borders. B The tumor is a histologically well-differentiated papillo-tubular adenocarcinoma. C An upper gastrointestinal endoscopy shows a fourth recurrence in the close vicinity of the jejunum and Y loop. D Gross pathology of the resection sample reveals a highly irregular cauliflower-like elevated mass measuring 5 x 3 cm extending beyond the serosa. Histology of the tumor is a well-differentiated papillo-tubular adenocarcinoma.
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F3
Nine months after the third operation, a mucosal lesion at the posterior wall of the esophago-jejunal anastomosis was found in the patient (Fig. 2C and 3A), and he underwent endoscopic submucosal dissection. The pathological examination revealed a well-differentiated adenocarcinoma (Fig. 3B), but there were no tumor cells at the margins of the resected specimen. The patient underwent a jejunal resection, partial resection of the liver and transverse and descending colons with a jejunal R-Y reconstruction (Fig. 2D and 3C). On gross examination of the resected sample, a highly irregular cauliflower-like elevated mass, measuring 5 x 3 cm, was found, which extended beyond the serosal surface (Fig. 3D).