2015 Volume 64 Issue 3 Pages 205-211
A 66-year-old man was admitted because of chest burning sensation. Endoscopic examination revealed mass lesion at the middle esophagus. Endscopic biopsies revealed squamous cell carcinoma. Preoperative CT and PET showed swollen lymph nodes of the bilatetal hilar lesions, mediastinum, abdomen and right supraclavicular lesion. The supraclavicular lymph nodes was extirpated. Noncaseating epitheloid cell granulous could be seen in the specimen, suggesting sarcoidosis. Chemotherapy using FP（Cisplatin and fluorouracil）regimen reduced accumulation of the PET, but multiple lymph node swellings being not changed. However, the patient underwent esophagectomy with D2 dissection. The resected specimen showed metastasis in only one lymph node, but noncaseating granuloma were seen in some lymph nodes. The patient discharged on 19th days after the operation, and he received 5 times of adjuvant chemotherapy using weekly FP（Nedaplatin+ fluorouracil）regimen. The coexistence of esophageal carcinoma and sarcoidosis and sarcoid reaction is rare, but when regional lymphadenopathy is newly found by radiological examination such as PET-CT, the possibility of systemic sarcoidosis and sarcoid reaction should be considered. In addition, we must not misdiagnose the findings as the advanced stage of esophageal cancer. Differential diagnosis by using the detailed examination is important.
