Abstract
A 56-year-old man had received pancreaticoduodenectomy for a tumor at the pancreas head that was revealed at a mass screening examination. Histological examination, however, revealed metastatic undifferentiated carcinoma in the lymph node located in the parapancreatic head instead of pancreatic head cancer. Incidentally, IIc type early gastric carcinoma (signet ring cell type) was also found in the gastric antrum. The original site of the metastatic cancer was not found at that time. Nine months later, a submucosal tumor (SMT) like lesion of the esophagus was found. He underwent esophagectomy, and histological examination of the surgical specimen revealed large cell type undifferentiated carcinoma with lymphoid stroma in the SMT-like lesion and another moderately differentiated squamous cell carcinoma closely oral to the SMT-like lesion. This undifferentiated carcinoma of the esophagus was regarded as the primary lesion of the metastatic cancer in the lymph node behind the pancreatic head. Most of the reported undifferentiated carcinomas of the esophagus are small cell type and without lymphoid stroma. The present case showed two separate esophageal carcinomas of different histological types and a gastric carcinoma. Most of the cells composing the lymphoid stroma were T-cells. The patients doing well without recurrent disease 28 months after the esophagectomy.
