Abstract
Small cell carcinoma of the esophagus is relatively rare and the prognosis is poor. We report here a rare case of metachronous esophageal cancer involving both small cell and squamous cell carcinomas. A 59-year-old man suffering from dysphasia was found upon endoscopy to have an esophageal cancer-type 2 lesion in the middle of the thoracic esophagus. Biopsy specimens revealed small cell carcinoma. Computed tomography showed invasion of the trachea and multiple lymph node metastases. Given the diagnosis of small cell esophageal carcinoma at cStage IVa (T4N3M0), we started chemotherapy with CDDP and CPT-11 concurrent with radiotherapy (total 50.4Gy), in accordance with the standard regimen for small cell carcinoma of the lung. After 11 courses of chemotherapy, computed tomography and endoscopy revealed the primary lesion and lymph node swelling had disappeared, and the treatment was considered a complete response. However, follow-up endoscopy revealed a new flat-elevated lesion in the abdominal esophagus, which we removed via endoscopic submucosal dissection. Histologically, the lesion was diagnosed as a moderately to poorly differentiated squamous cell carcinoma without an endocrine component, invading slightly the muscularis mucosa. Horizontal and vertical margins were negative in the specimen. There was no lymphatic or venous invasion. Since the diagnosis of small cell esophageal carcinoma 3.5 years ago, the patient has never shown any evidence of recurrence.
