Abstract
We reported a case of esophageal cancer associated with the proximal margin of an esophageal ulcer located in the middle esophagus, relatively rare disease. Diagnosis of this case was very difficult because of the special clinical course. The patient was a 56-year old woman who visited us with a chief complaint of precordial pain. By X-ray examination of the upper gastrointestinal tract and esophageal endoscopy, she was admitted under a diagnosis of an acute middle esophageal ulcer. The ulcer healed rapidly in about 2 weeks after admission, but the proximal margin of the ulcer tended to gradually increase in size. Macroscopically, the proximal protuberance was surmised to be a carcinoma, so biopsies were performed several times but without detection of any malignant cells. About 1 month later, the protuberance became clearer and squamous cell carcinoma was confirmed by biopsy obtained from a small concavity in the center of the lesion. An operation was thus performed. Postoperative histopathological examination showed that the carcinoma located beneath the protuberance. The carcinoma was mostly covered with normal mucosa and only a part of it was exposed. The morphology of the carcinoma and the timecourse changes in the acute ulcer were thought to be the factors which made diagnosis difficult.
