A CASE OF ESD OF SUPERFICIAL ESOPHAGEAL CANCER ASSOCIATED WITH ESOPHAGEAL ACHALASIA

Abstract

The association between esophageal squamous cell carcinoma and esophageal achalasia has been well known. However, almost all cases of esophageal carcinoma are in the advanced stage when they are detected. We herein report a case of coexisting superficial esophageal carcinoma with esophageal achalasia and successful treatment with minimally invasive surgical modalities. A 74-year-old woman was referred for the treatment of superficial carcinoma of the esophagus associated with esophageal achalasia. She has been suffering from achalasia for the past 20 years. Periodic endoscopic examination detected slightly depressed irregular mucosa in the upper thoracic esophagus, and histopathological examination of biopsy specimens revealed squamous cell carcinoma. Magnified narrow band imaging during endoscopic examination showed irregular intra-epithelial capillary loops in the lesion and we diagnosed the depth of tumor invasion as T1a-LPM. Esophageal achalasia was diagnosed as the sigmoid type and the maximum diameter of the esophagus was 4.5 cm as observed on barium swallow. We first performed endoscopic submucosal dissection (ESD) of the superficial esophageal carcinoma. Histopathological findings of the resected specimen revealed squamous cell carcinoma and the tumor invaded the lamina propria mucosa (LPM) without any vascular invasion. Four months later, we performed laparoscopic surgery for esophageal achalasia. She is well and alive without tumor recurrence and without any symptoms related to esophageal achalasia.