PMC4701824_01
Esophagogastroscopy and barium esophagography for small-cell carcinoma. (a) Esophagogastroscopy performed at admission revealed an ulcerated mass in the upper thoracic esophagus. (b) Esophagogastroscopy after one course of preoperative chemotherapy with cisplatin and irinotecan revealed that the lesion had markedly flattened. (c) Esophagogastroscopy after two courses of preoperative chemotherapy with cisplatin and irinotecan failed to detect any remaining signs of the tumor. (d) A barium esophagram generated upon admission revealed a 20-mm mass with central ulceration in the upper thoracic esophagus.
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Esophagogastroscopy revealed an ulcerated mass in the upper thoracic esophagus (Fig. 1a), and histopathological examination of the biopsy showed primary small-cell carcinoma (Fig. 2). A barium esophagram revealed a 20-mm mass with central ulceration in the upper thoracic esophagus (Fig. 1d). Adverse Events Version 4.0) was observed during each course, whereas grade 3/4 adverse effects were not observed. After one course of chemotherapy, esophageal endoscopy revealed that the primary lesion in the esophagus had markedly flattened (Fig. 1b). Furthermore, after two courses of treatment, the tumor could not be detected (Fig. 1c).
Chest computed tomography. (a) CT at admission shows wall thickening in the upper thoracic esophagus. (b) After one course of preoperative chemotherapy, the wall thickening in the upper thoracic esophagus was reduced. (c) After two courses of preoperative chemotherapy, the wall thickening in the upper thoracic esophagus could not be detected. (d) The enlarged right recurrent nerve lymph node at admission. (e) After one course of preoperative chemotherapy, the swelling of the right recurrent nerve lymph node was reduced. (f) After two courses of preoperative chemotherapy, the swelling of the right recurrent nerve lymph node could not be detected.
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Computed tomography (CT) scan revealed an esophageal-wall thickening (Fig. 3a) and enlarged right recurrent nerve lymph node (Fig. 3d). A CT scan revealed a reduction in the esophageal-wall thickening (Fig. 3c), and the swelling of the right recurrent nerve lymph node (Fig. 3f) was not detected.
Surgical specimen of the esophagus. No residual tumor tissue could be detected.
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One month after the conclusion of chemotherapy, radical esophagectomy with three-field lymph node dissection and gastric tube reconstruction was performed using a thoracoscopic approach in the prone position, laparotomy, and bilateral cervical approaches (Fig. 4).