2010 Volume 43 Issue 1 Pages 33-37
We report a rare case of triple primary malignant diseases, i.e., malignant nodal lymphoma at esophagectomy with lymh node dissection for esophageal and laryngeal cancer. A 64-year-old man admitted for anemia was found in endoscopic study to have a superficial, slightly depressed tumor of the lower thoracic esophagus. Histologically, the diagnosis was well-differentiated squamous cell carcinoma found in endoscopic ultrasonography to have infiltrated the submucosa. Leukoplakia of the membranous portion of the left vocal cord was histologically diagnosed as well-differentiated squamous cell carcinoma. No lymph node metastasis was detected, but subcarinal lymph node swelling shown by computed tomography (CT) was judged to be an inflammatory reaction. The preoperative esophageal cancer stage was stage I, T1bN0M0, which was treated by thoracoscopy -assisted subtotal esophagectomy (D3) and laparoscopic reconstruction with a gastric tube. The stage I, T1N0M0, laryngeal cancer was treated by laser microlaryngeal surgery. A left subbronchial lymph node that had infiltrated to the esophageal adventitia was histological stage 0, T1aN0M0. No lymph node metastasis from squamous cell carcinoma was detected in the 59 dissected lymph nodes, but the subcarinal and left subbronchial nodes were diagnosed with diffuse large B cell lymphoma positive for CD79a and L26. Following three courses of rituximab-CHOP (R-CHOP) and irradiation, discharged with malignant lymphoma in remission.
