A Case of Esophageal Cancer Arisen in a Diverticulum of the Lower Esophagus Performed Combined Lung Resection

Abstract

A 55-year-old woman with a previous history of esophageal diverticulum was referred to our hospital because of recurrent bouts of pneumonia. Contrast-enhanced CT scan revealed an irregularly thickening wall of the esophageal diverticulum with enhancement effect, and involvement of the left atrium of heart and the right inferior pulmonary vein was likely. Upper gastrointestinal endoscopy showed a type 3 tumor in the diverticulum, with fistulation to the lung. A biopsy offered a diagnosis of squamous cell carcinoma. We performed neoadjuvant chemotherapy (2 courses of FP regimen), followed by operation. The operative procedures included resection of the thoraco-abdominal esophagus and upper part of the stomach by right thoracotomy and laparotomy, and reconstruction through retro-sternal route using a gastric tube. Furthermore involvement of the right inferior pulmonary vein was identified and combined resection of the right lower lobe of the lung was done. Intraoperative frozen section diagnosis of the surgical margin dissected from the descending aorta was reported to be cancer negative, however, the final pathological diagnosis was cancer positive. After the operation, irradiation therapy was conducted mainly for the dissected surface from the descending aorta.
Esophageal cancer arisen in an esophageal diverticulum is rare and easily invades the surrounding tissues. We report a case of cancer in a lower esophageal diverticulum invading the right inferior pulmonary vein which was removed with combined lung resection, together with a review of the literature.