Case report of middle thoracic esophageal adenocarcinoma at the oral margin of barrett's epithelium

Abstract

A 66-year-old woman was hospitalized because of dysphagia and weight loss. Esophagoscopy showed a type 3 tumor at the middle thoracic esophagus, and endoscopic biopsy confirmed adenocarcinoma of the esophagus. The CEA level before the operation was 43.3 ng/ml. Abdominal and chest CT examination revealed lymph node metastases. The clinical stage was III (T3, N2, M0). A subtotal esophagectomy with right thoracotomy was performed. The pathological diagnosis was Barrett's esophageal cancer, moderately differentiated adenocarcionma and lymph node metastases (pT3, pN2, sM0, ly1, v0, fStageIII). Barrett's epithelium was found from the esophagogastric junction to the anal margin of the tumor, but not on the oral side of the tumor. Immunohistological staining for CEA was positive. After surgery, the CEA level decreased to normal range. Adjuvant chemotherapy with docetaxel, cisplatin and 5-FU was administered. After this therapy, CT examination showed liver and lung metastases. We then conducted TS-1/CPT-11 as second-line chemotherapy. Her disease has remained stable since she undergwent this chemotherapy.