Dermatomyositis (DM) is a kind of idiopathic inflammatory myopathy characterized by chronic proximal skeletal muscle weakness and unique skin lesions. However, DM with exfoliation of esophageal mucosa is rare. A 36-year-old male patient complained of muscular soreness of extremities, dysphagia, and pharyngalgia was diagnosed with DM with exfoliation of esophageal mucosa. After treatment with glucocorticoid, immunosuppressant, acupuncture, and endoscopic submucosal dissection (ESD), the above symptoms were disappeared. During the 3-year follow-up period, the results of routine physical examination, laboratory examination, gastroscopy, and imaging examination were normal. High-dose of corticosteroid is needed in the initial treatment, but it must be reduced regularly to avoid adverse reactions. Acupuncture and ESD are also effective as adjuvant therapy.
Adult ; Dermatomyositis/complications* ; Endoscopic Mucosal Resection ; Esophageal Mucosa ; Esophageal Neoplasms ; Gastroscopy ; Humans ; Male ; Treatment Outcome

Intestinal mucosa plays important roles in digestion, absorption and substance exchange between organism and external environment. Meanwhile, it is the largest immune organ and mucosal barrier, including mechanical, biological and immune barrier. A variety of diseases, especially postoperative complications, are associated with the damage of mucosal barrier. Esophageal cancer surgery is complex and many perioperative factors, especially hypoperfusion and fasting, may affect the integrity of intestinal barrier. Understanding of the mechanism of intestinal barrier (mechanical, biological and immune barrier), the physiological function of probiotics, and the benefit of early enteral nutrition to intestinal barrier are important components to achieve fast recovery after surgery for esophageal cancer.
Enteral Nutrition ; Esophageal Neoplasms ; surgery ; therapy ; Humans ; Intestinal Mucosa ; Perioperative Period

The primary esophageal lymphoma is extremely rare, and shows various morphologic characteristics. Only a single case of mucosa-associated lymphoid tissue (MALT) type lymphoma confined to the esophagus has been reported in the literature. A 61-yr-old man was referred to our hospital for evaluation of an esophageal submucosal tumor (SMT) that had been detected incidentally by endoscopy. He had a history of pulmonary tuberculosis with long-term anti-tuberculosis medication 15 yr before, and also had a history of syphilis, which had been treated one year before. He had been taking a synthetic thyroid hormones for the past 10 months because of an autoimmune thyroiditis. Endoscopy showed a longitudinal round and tubular shaped smooth elevated lesion, which was covered with intact mucosa and located at the mid to distal esophagus, 31 cm to 39 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a huge longitudinal growing intermediate- to hypo-echoic mass located in the submucosal layer with internal small, various sized honeycomb-like anechoic lesions suggesting germinal centers. Subsequently, he underwent a surgery, which confirmed the mass as a primary esophageal low-grade B-cell lymphoma of MALT type.
Alcoholism/complications ; Diagnosis, Differential ; Esophageal Neoplasms/pathology* ; Esophageal Neoplasms/radiography ; Esophageal Neoplasms/ultrasonography ; Esophagoscopy ; Gastritis/complications ; Helicobacter Infections/complications ; Hemangioma, Cavernous/diagnosis ; Human ; Incidental Findings ; Lymphoma, Mucosa-Associated Lymphoid Tissue/pathology* ; Lymphoma, Mucosa-Associated Lymphoid Tissue/radiography ; Lymphoma, Mucosa-Associated Lymphoid Tissue/ultrasonography ; Male ; Middle Aged ; Mucous Membrane/pathology ; Neoplasm Invasiveness ; Smoking ; Thyroiditis, Autoimmune/complications

Heterotopic gastric mucosa in the upper esophagus is frequently found during endoscopic examination. Although most patients with heterotopic gastric mucosa of the upper esophagus, referred as inlet patch, are asymptomatic, symptomatic patients with complications resulting from this ectopic mucosa have also been reported. Acid secretion by the inlet patch has been suggested in some reports. We report a case of heterotopic gastric mucosa in the upper esophagus, with secretion of acid, demonstrated by continuous ambulatory pH monitoring, and the improvement of pharyngeal symptoms after the use of a proton pump inhibitor.
Adult ; Ambulatory Care ; Anti-Ulcer Agents/administration & dosage ; Case Report ; Choristoma/diagnosis* ; Esophageal Diseases/drug therapy ; Esophageal Diseases/diagnosis* ; Esophagoscopy ; Gastric Acid/secretion* ; Gastric Mucosa/secretion* ; Human ; Hydrogen-Ion Concentration ; Male ; Monitoring, Physiologic/methods ; Prognosis

BACKGROUNDEndoscopic submucosal dissection of the esophagogastric junction is the most difficult gastric and esophageal dissection procedure. No reports of endoscopic submucosal dissection for Siewert type II carcinoma of the esophagogastric junction have compared the outcomes of endoscopic submucosal dissection for all three Siewert types of adenocarcinoma. This study aimed to evaluate the efficacy and safety of endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction.

METHODSFrom October 2008 to June 2013, 73 patients underwent endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction. The patients were prospectively evaluated regarding the executability of the technique, short-term results of the procedure, en bloc resection rate, curative resection rate, complications and additional treatment after endoscopic submucosal dissection, and follow-up outcomes.

RESULTSSixty-eight of the 73 patients (93.2%) underwent en bloc resection; the mean maximum specimen diameter was 33.7 mm. Fifty-seven of 61 patients (93.4%) who underwent curative resection were successfully followed-up for 1.0 to 56.0 months (average, 24.1 months). Local recurrence developed in one patient with high-grade intraepithelial neoplasm. Twelve patients underwent noncurative resection, including lateral resection margin residues in three, vertical resection margin residues in one, signet ring cell carcinoma or undifferentiated adenocarcinoma in four, lymphatic or vessel invasion in one, vertical residual margin residues combined with signet ring cell carcinoma in one, and undifferentiated adenocarcinoma with lymphatic or vessel invasion in two. In the noncurative resection group, one patient was lost to follow-up, seven underwent additional surgery, and the remaining four were periodically followed up; none had local recurrence or distant metastases. The only complication was delayed bleeding in three patients, which was successfully controlled by conservative treatment or endoscopic therapy.

CONCLUSIONSEndoscopic submucosal dissection is safe and effective for intraepithelial neoplasia of the esophagogastric junction. R0 en bloc resection is possible and can avoid the risk of local recurrence.

Adult ; Aged ; Aged, 80 and over ; Carcinoma in Situ ; surgery ; Dissection ; adverse effects ; methods ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; surgery ; Female ; Gastric Mucosa ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies

PURPOSE: Many clinics have abandoned the use of a proximal subtotal gastrectomy for adenocarcinomas of the stomach because of the poor survival rate, the high incidence of operative complication, and the lack of an advantage saving the antral stump. The authors performed an esophagogastrostomy after a proximal subtotal gastrectomy without pyloroplasty and evaluated the outcome of this pylorus-preserving proximal subtotal gastrectomy. METHODS: After the pylorus-preserving proximal subtotal gastrectomy in 16 patients with a gastric adenocarcinoma, the status of the esophageal and gastric mucosa was evaluated using endoscopy, and the function of the pylorus was estimated using an upper gastrointestinal series. In this clinical study, the data were collected between September 1996 and August 1999 at Chungnam National University Hospital. RESULTS: The function of the pylorus of the stomach was well preserved without any severe reflux from the duodenum. The incidences of esophagitis and gastritis were 11 out of 16 patients and 3 out of 16 patients, respectively, in this operation. Esophageal stricture developed in 5 out of 16 patients. CONCLUSION: The pylorus-preserving proximal subtotal gastrectomy (without conventional pyloroplasty) is effective in terms of preventing postoperative reflux gastritis. The emptying mechanism of the pyloric sphincter and the reservoir function of the stomach were well preserved in this study. We think that the pylorus-preserving proximal subtotal gastrectomy is one of useful methods for early adenocarcinomas of the proximal stomach. However, reflux esophagitis and stricture of the esophagogastrostomy site are common problems to be solved in the future.
Adenocarcinoma ; Chungcheongnam-do ; Constriction, Pathologic ; Duodenum ; Endoscopy ; Esophageal Stenosis ; Esophagitis ; Esophagitis, Peptic ; Gastrectomy* ; Gastric Mucosa ; Gastritis ; Humans ; Incidence ; Pylorus* ; Stomach ; Survival Rate

BACKGROUND/AIMS: Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach. METHODS: We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012. RESULTS: The mean age was 48.9 years old and male to female ratio was 2.6:1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%). CONCLUSIONS: Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.
Adult ; Aged ; Esophageal Neoplasms/*pathology/*surgery/ultrasonography ; Esophagus/pathology ; Female ; Gastrointestinal Stromal Tumors/diagnosis/surgery ; Humans ; Intestinal Mucosa/*pathology ; Leiomyoma/diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy

Hemangioma of the esophagus is a rare form of benign esophageal tumor. It usually presents as a single lesion located in the lower third of the esophagus and is mostly asymptomatic. However, it may occasionally cause hematemesis and/or obstruction. Surgical resection is the conventional treatment modality for managing esophageal hemangioma, but less invasive approaches such as endoscopic therapy are recently becoming more widely employed. Herein, we report a case of a 54-year-old man who presented with an esophageal hemangioma that was successfully treated by endoscopic mucosal resection without any complications.
Antigens, CD31/metabolism ; Esophageal Diseases/*diagnosis/surgery ; Esophagoscopy ; Esophagus/diagnostic imaging/metabolism/pathology ; Hemangioma/*diagnosis/surgery ; Humans ; Intestinal Mucosa/metabolism/pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Heterotopic gastric mucosa in the upper esophagus, in which the inlet patch is a salmon-colored valvet patch, is located mainly below the upper esophageal sphincter. The acid secretion and inflammation from heterotopic gastric mucosa causes laryngopharyngeal symptoms. Generally, the management of heterotopic gastric mucosa depends on the symptoms, and the condition is generally treated by proton pump inhibitor. Recently, it was reported that argon plasma coagulation (APC) is effective when medical treatment fails. A 49-year-old man and a 44-year-old woman with symptoms of globus sensation and hoarseness visited this clinic. An upper gastrointestinal endoscopy showed a flat salmon-colored patch located at the upper esophagus. The former patient failed medical treatment and the latter did not require long term medical treatment. Therefore, the patients were treated with APC, which resulted in an improvement in symptoms. APC treatment may improve the symptoms of patients with heterotopic gastric mucosa of the cervical esophagus.
Adult ; Argon ; Argon Plasma Coagulation ; Bays ; Endoscopy, Gastrointestinal ; Esophageal Sphincter, Upper ; Esophagus ; Female ; Gastric Mucosa ; Hoarseness ; Humans ; Inflammation ; Middle Aged ; Proton Pumps ; Sensation

Multiple primary cancers, i.e., the occurrence of multiple malignant neoplasms in a single patient, were first reported by Billorth in 1889. The incidence is low but increasing gradually due to developments in cancer diagnosis, early detection, and prolongation of life. In Korea, double primary cancers are occasionally reported. However, the simultaneous presence of four primary cancers in a single patient is rare. Recently, we experienced the case of a 68-year-old male diagnosed with quadruple primary cancers involving the esophagus, tonsils, liver and buccal mucosa. Here, we report this very rare case of four metachronous primary neoplasms and provide a brief review of the related literature.
Aged ; Early Diagnosis ; Esophageal Neoplasms ; Esophagus ; Gastrointestinal Tract* ; Head and Neck Neoplasms ; Head* ; Humans ; Incidence ; Korea ; Life Support Care ; Liver ; Male ; Mouth Mucosa ; Neck* ; Palatine Tonsil