A Case of Surgical Radical Resection of Carcinoma in an Epiphrenic Esophageal Diverticulum

Abstract

The frequency of esophageal diverticulum in Japan is about 1.6%. Carcinoma in esophageal diverticulum is very rare, occurring in comprising 0.6% of the cases. Epiphrenic esophageal diverticulum is a pseudodivertilulum that lacks the muscularis propria, thus a carcinoma arising in it can easily invade surrounding organs. In addition, they lack symptoms such as transit disturbance, and are more likely to be detected in an advanced stage with poorer prognosis. A 72-year-old woman underwent a routine medical checkup for an epiphrenic diverticulum. Six years later, upper gastrointestinal endoscopy revealed a 20-mm-sized 0-IIb lesion recognized as a clear iodine unstained area in the diverticulum. A biopsy revealed squamous cell carcinoma and a diagnosis of cT1a-EP/LPM, N0, M0, cStage 0. Esophageal manometry showed no abnormal findings. Endoscopic resection was considered, but surgical resection was decided because of chronic cough, reflux esophagitis, and proximity of the tumor margin to the diverticular orifice. Thoracoscopic radical subtotal esophagectomy was performed and R0 resection was obtained. The pathological diagnosis was pT1a-MM, N0, M0, fStage 0. We experienced a case in which surgical radical resection was possible by early detection of carcinoma in epiphrenic diverticulum with periodic observation. This case is reported with some discussion of the literature.