Abstract
A 42-year-old man presenting with dysphagia and who underwent esophagogastroduodenoscopy was found to have a tumor in the lower thoracic esophagus with hiatus hernia and a submucosal gastric tumor. We suspected he had Barrett’s esophagus because endoscopy revealed that the columnar epithelium existed at the proximal side of the oral margin of the longitudinal folds along the greater curvature of the stomach. Histologically, biopsy specimens of the esophageal tumor indicated adenocarcinoma but gastric tumor specimens suggested no malignancy. CT showed swelling of several abdominal lymph nodes. He was treated with subtotal esophagectomy and two-field lymph node dissection with right thoracotomy followed by a reconstruction procedure using a gastric tube. The submucosal tumor of the stomach was resected at the preparation of the esophageal substitution. He had complications of left recurrent laryngeal nerve palsy, but the postoperative course was uneventful. Therefore, he was discharged on postoperative day 16. Histopathological examination of the resected specimen showed adenocarcinoma in the submucosal layer of the stomach and esophageal gland beneath the overlying columnar epithelium. A final diagnosis of Barrett’s esophageal adenocarcinoma with intramural metastasis to the stomach was given. Because of 16 lymph node metastases from the upper mediastinum to the abdomen, he received chemotherapy with S-1 and cisplatin followed by S-1 for one year. The patient has been well without recurrence for 41 months after esophagectomy.
