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Carcinoma Arising in a Middle Esophageal Diverticulum with Multiple Foci of Carcinoma in Situ and Dysplasia, Report of a Case S. Okamura 1 , S. Nakazawa 1 , S. Kawaguchi 1 , J. Yoshino 1 , M. Iwata 1 1The Second Department of Internal Medicine, School of Medicine, Nagoya University pp.1215-1221
Published Date 1983/11/25
DOI https://doi.org/10.11477/mf.1403109267
  • Abstract
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 A 65 year-old man, who had had a symptom of dysphagia for approximately 40 years, was referred to our hospital for further diagnosis of the diverticulum pointed out by mass survey for GI tract in October 1982. The diverticulum in the middle esophagus was pointed out in an other hospital several years ago. Physical and laboratory examination revealed poor nutrition and obstructive pulmonary dysfunction. Radiological examination showed the huge diverticulum measuring 5.5×9.0 cm in the middle esophagus, and another small diverticulum in the lower esophagus. Superficial type carcinoma arising in the middle esophageal diverticulum was revealed by means of both x-ray and endoscopic examination (Fig. 1, 2 a). The lesion was disclosed as unstained area under endoscopic iodine staining method (Fig. 2b). Endoscopic film showed scattered erosions around the diverticulum in addition (Fig. 2c, d).

 The resected specimen showed a 5.5×6.0 cm diverticulum in the middle esophagus, in which superficial type carcinoma measuring about 2.5×3.0 cm was recognized (Fig. 3), and another diverticulum in the lower esophagus. No other abnormal findings were detected out of the diverticula. Histologically, the main tumor in the diverticulum was well differentiated squamous cell carcinoma invading adventitia definitely (Fig. 4a, b). Metastasis was not found in lymph nodes or in other organs. Intraepithelial carcinomatous spread was present on the proximal side of the lesion (Fig. 4c). On the other hand, multiple foci of carcinoma in situ and dysplasia of various degree were detected in and around the diverticulum (Fig. 4d~f). Both diverticula were considered to be the true diverticulum histologically. The patient is alive six months after the operation.


Copyright © 1983, Igaku-Shoin Ltd. All rights reserved.

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