Metachronous Multiple Thoracic Esophageal Cancers with Sarcoid Reaction—Report of a Case—

Abstract

A 72-year-old man had been followed for three years after undergoing endoscopic submucosal resection for early esophageal squamous cell carcinoma, with no recurrence. However, one year earlier, computed tomography and positron emission tomography scans showed enlarged lymph nodes in the right supraclavicular, hilar, and mediastinal regions, and biopsy findings suggested sarcoidosis. The patient continued to show no symptoms and remained under observation. A recent follow-up upper gastrointestinal endoscopy then showed superficial esophageal carcinoma. Since the lymph nodes showed no remarkable changes in size compared with one year earlier, the preliminary diagnosis was esophageal squamous cell carcinoma cT1bN0M0 Stage I, and radical resection was performed. The histopathological findings showed mediastinal lymph node metastasis, and the final diagnosis was confirmed to be esophageal cancer fT1bN1M0 Stage II A. While the lymph nodes showed a non-caseating epithelioid cell granuloma component, and there were no clinical symptoms of sarcoidosis. Accordingly the final diagnosis was sarcoid reaction. In this case, due to the mediastinal lymph node swelling associated with sarcoid reaction, it was difficult to distinguish between lymph node metastases and sarcoid reaction preoperatively. Neoadjuvant chemotherapy could be considered for patients diagnosed with cT1b esophageal cancer with sarcoid reaction due to the potential risk of lymph node metastasis.