Abstract
This paper presents a case of gastric cancer with intramural metastasis to the esophagus for which endoscopic submucosal dissection (ESD) was effective. A 61-year-old man underwent a total gastrectomy for advanced gastric cancer in August 2009. Histologically, the gastric cancer was confirmed to be a moderately differentiated adenocarcinoma and the proximal margin of the resected specimen was free of cancer cells. The TNM stage of the gastric cancer was pT3 (tumor invades the subserosa) pN0M0. One year after the operation, the patient underwent a routine examination by upper gastrointestinal endoscopy. Because the endoscopic examination revealed a tumor in the lower esophagus that macroscopically resembled a 0-IIa type primary esophageal cancer, he underwent endoscopic mucosal resection (EMR) in October 2010. The tumor resected by EMR was histologically confirmed to be a moderately differentiated adenocarcinoma and displayed the same characteristics as the previously resected gastric cancer. Histological examination showed that the vertical margin of the EMR specimen was positive for cancer cells. Then, the patient underwent endoscopic submucosal dissection (ESD) in December 2010. Histologically, the ESD specimen was shown to be a moderately differentiated adenocarcinoma and it was confirmed that very little tumor tissue had been present in the submucosa at the time of ESD. The horizontal and vertical margin of the ESD specimen was free of cancer cells. At present the patient is alive without recurrence 31 months after the ESD.
