A 61-year-old man with no history of malignancy presented with a rapidly expanding left periorbital mass, first noticed one month prior to presentation. The mass was firm, and a pus-like discharge drained spontaneously from the center of the lesion. A biopsy was performed, and histopathology confirmed squamous cell carcinoma. Systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases. The prognosis of orbital metastasis is generally poor, and this patient expired after one month of conservative treatment.
Abscess/diagnosis ; Biopsy ; Carcinoma, Squamous Cell/*diagnosis/*secondary ; Diagnosis, Differential ; Esophageal Neoplasms/*pathology ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Orbital Diseases/diagnosis ; Orbital Neoplasms/*diagnosis/*secondary

No abstract available.
Carcinoma, Squamous Cell/*diagnosis/*pathology/*secondary ; Early Detection of Cancer/*statistics & numerical data ; Esophageal Neoplasms/*diagnosis/*secondary ; Female ; Head and Neck Neoplasms/*pathology ; Humans ; Male

No abstract available.
Carcinoma, Squamous Cell/*diagnosis/*pathology/*secondary ; Early Detection of Cancer/*statistics & numerical data ; Esophageal Neoplasms/*diagnosis/*secondary ; Female ; Head and Neck Neoplasms/*pathology ; Humans ; Male

Primary malignant melanoma of the esophagus is exceedingly rare. The existence of primary malignant melanoma in the esophagus had been in doubt until the presence of benign melanocytes was demonstrated within the esophagus. Hematogenous and lymphatic metastases are common. The prognosis is poor even after a radical procedure due to early metastasis. We report here two cases of primary malignant melanoma of the esophagus. One is a melanotic melanoma and the other is an amelanotic melanoma.
Adult ; Case Report ; Endoscopy ; Esophageal Neoplasms/pathology* ; Female ; Human ; Liver Neoplasms/secondary ; Liver Neoplasms/radiography ; Male ; Melanoma/pathology* ; Melanoma, Amelanotic/pathology* ; Middle Age ; Tomography, X-Ray Computed

Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a recently recognized malignant neoplasm of the thyroid gland. About 14 cases of SMECE have been reported and this is the first reported case in Korea. A 57-year-old woman presented with right neck mass for 20 years. Total thyroidectomy was performed under the impression of thyroid carcinoma. The resected thyroid gland showed a poorly circumscribed hard mass. Histologically, the tumor consisted of solid nests of large atypical cells with dense fibrous stroma. The tumor cells showed squamoid appearance with abundant eosinophilic cytoplasm. There were also rare mucin-containing cells within the nests. Within the hyalinized stroma, numerous eosinophils were found. The surrounding thyroid parenchyma displayed Hashimoto's thyroiditis. There was metastasis in a regional lymph node. Two years after initial surgery, she underwent a modified radical neck dissection due to recurrent neck mass. After the radiation therapy for eight weeks, laryngectomy and esophagectomy were performed due to a recurrent carcinoma in the esophageal wall. We report an additional case of SMECE, with metastasis to regional lymph nodes and esophagus. The tumor appears to be more aggressive than previously reported and a correct diagnosis can be rendered by just examining the metastatic lesions.
Carcinoma, Mucoepidermoid/surgery ; Carcinoma, Mucoepidermoid/secondary* ; Carcinoma, Mucoepidermoid/pathology* ; Carcinoma, Mucoepidermoid/complications ; Case Report ; Eosinophilia/pathology ; Eosinophilia/complications* ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/secondary* ; Female ; Human ; Laryngectomy ; Lymph Nodes ; Middle Age ; Recurrence ; Sclerosis ; Thyroid Gland/pathology* ; Thyroid Neoplasms/surgery ; Thyroid Neoplasms/pathology* ; Thyroid Neoplasms/complications ; Thyroiditis, Autoimmune/complications

OBJECTIVETo explore the influence of 5'UTR tandem repeat and 3'UTR 6 bp deletion polymorphism of thymidylate synthase (TS) gene on the development and lymphatic metastases of esophageal squamous-cell carcinoma (ESCC).

METHODSPeripheral leucocyte DNA was extracted from 232 ESCC patients and 348 age- and sex-matched healthy controls. TS 5'UTR and 3'UTR genotyping in all study subjects was performed by PCR fragment analysis and PCR-RFLP analysis, respectively.

RESULTSThe distribution of TS 5'UTR and 3'UTR variants in ESCC patients was not significantly different from that in healthy controls. However, individuals with 6 bp+/6 bp+ and 3R/3R genotypes significantly reduced the risk to ESCC development compared to those with other genotype combinations (adjusted OR = 0.32, 95% CI = 0.08-0.92). In addition, the frequency of 2R/3R genotype in ESCC patients with lymphatic metastases (40%) was significantly higher than that in lymph node negative cases (14.7%) (chi(2) = 10.11, P = 0.001). Compared to 3R/3R genotype, the 2R/3R genotype significantly increased the risk of lymphatic metastases in ESCC (adjusted OR = 3.68, 95% CI = 1.54-8.93).

CONCLUSIONThe genotyping of TS 5'UTR and 3'UTR polymorphisms might be used as a stratification maker for predicting susceptibility to ESCC. The TS 5'UTR 2R/3R genotype might be a candidate molecular marker to predict the potential of lymphatic metastases in ESCC.

Biomarkers, Tumor ; Carcinoma, Squamous Cell ; genetics ; secondary ; Esophageal Neoplasms ; genetics ; pathology ; Genotype ; Humans ; Lymphatic Metastasis ; Polymorphism, Genetic ; Tandem Repeat Sequences ; genetics ; Thymidylate Synthase ; genetics

OBJECTIVEWe analyzed the lymph node (MLNs) metastasis of thoracic esophageal squamous cell carcinoma (ESCC) to explore the patterns of lymphatic spread and the rational surgical procedure and extent of lymph node dissection for ESCC.

METHODSWe retrospectively evaluated 313 consecutive patients treated in our hospital between January 2010 and May 2014 who underwent minimally invasive esophagectomy (MIE) for ESCC. The information of lymph node status was obtained and the features of lymph node metastasis were analyzed.

RESULTSOf the 313 cases, 122 (39.0%) were found to have lymph node metastasis. In the 4461 dissected lymph nodes, metastasis was identified in 294 (6.6%) lymph nodes. The recurrent laryngeal nerve lymph nodes were the most frequent metastatic nodes with a metastasis rate of 25.2%, followed by the paracardiac and left gastric artery lymph nodes (18.2%). Chi-square test showed that the lymph node metastasis is associated with tumor invasion and tumor differentiation (P<0.001 for both). Metastases were more frequently found in the recurrent laryngeal nerve lymph nodes in patients with tumors in the upper third esophagus and with histologically poor differentiation (P<0.05 for both). The metastasis rate of para-cardiac and left gastric artery lymph nodes was associated with tumor in the lower third of esophagus, T stage and differentiation (all P<0.05). Logistic regression analysis showed that tumor differentiation and location are independent factors affecting the metastasis of recurrent laryngeal nerve lymph nodes (P<0.05 for all). T stage, tumor differentiation and location were independent factors associated with metastasis of para-cardiac and left gastric artery lymph nodes (P<0.05 for all).

CONCLUSIONS(1) Metastases of thoracic esophageal carcinoma are often found in the recurrent laryngeal nerve lymph nodes, para-cardiac and left gastric artery lymph nodes. (2) Extensive lymph node dissection should be performed for ESCC with poor differentiation and deep tumor invasion.

Carcinoma, Squamous Cell ; secondary ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Lymphatic Vessels ; Recurrent Laryngeal Nerve ; Retrospective Studies

OBJECTIVEThe aim of this study was to evaluate the effect of postoperative adjuvant therapy on the survival in patients with N1 lymph node metastasis of esophageal squamous cell carcinoma (ESCC).

METHODS110 patients with positive N1 lymph node metastasis of esophageal squamous carcinoma were included in this study. The surgery group included 46 cases and the postoperative adjuvant therapy group included 64 cases (24 cases in the adjuvant chemotherapy subgroup and 40 cases in the adjuvant concurrent chemoradiotherapy). The disease-free survival (DFS) and overall survival (OS) of the two groups were compared and the prognostic factors were analyzed by multivariate Cox model.

RESULTSIn the postoperative adjuvant therapy group, the DFS (16.8 months) and OS (21.3 months) were significantly prolonged compared with those in the surgery group (10.6 months, P=0.007) and (13.7 months, P=0.001), respectively. Postoperative adjuvant chemotherapy significantly extended the OS (31.1 months) of N1-positive patients compared with 13.7 months (P=0.002) in the surgery group. But there were no significant differences between the DFS in the two subgroups (16.3 and 16.8 months, P=0.346) and between the OS (23.4 and 21.3 months, P=0.491). Postoperative adjuvant therapy was an independent prognostic factor in the ESCC patients with N1 lymph node metastasis.

CONCLUSIONPostoperative adjuvant therapy can improve the prognosis and prolong the survival time in ESCC patients with positive N1 lymph node metastasis.

Carcinoma, Squamous Cell ; mortality ; secondary ; therapy ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Esophageal Neoplasms ; mortality ; pathology ; therapy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Postoperative Care ; Prognosis ; Retrospective Studies

OBJECTIVETo explore the patterns and influencing factors of lymph node metastasis in limited esophageal small cell carcinoma (PESCC).

METHODSA total of 98 limited stage PESCC patients who underwent surgery were selected for this study. The lymph node metastasis ratio at different sites, depth of invasion, tumor length and other factors were analyzed to assess their influence on lymph node metastasis.

RESULTSAmong the 98 PESCC cases, 46 cases had lymph node metastasis (46.9%). 100 out of 833 lymph nodes had metastasis, with a metastasis ratio of 12.0%. For upper thoracic esophageal small cell carcinomas, lymph node metastasis ratios were 42.9%, 12.5%, 0 and 0 in the superior mediastinum, middle mediastinum, inferior mediastinum and abdominal cavity, respectively. In the middle thoracic PESCCs, the lymph node metastasis ratios were 18.8%, 7.7%, 15.7%, and 15.3%, respectively. In the lower thoracic PESCCs, the lymph node metastasis ratios were 0, 0, 27.3% and 23.5%, respectively. Lymph node metastasis rates in PESCCs at stages T1, T2, T3, T4 were 15.4%, 42.3%, 63.9%, and 80.0%, respectively. The lymph node metastasis ratios in PESCCs at stages T1, T2, T3, T4 were 2.0%, 8.3%, 17.8% and 25.0%, respectively. Lymph node metastasis rate and lymph node metastasis ratio at different T stages were of significant difference (P<0.05 for all). Lymph node metastasis rates in patients with tumor <3 cm, 3-5 cm, and >5 cm were 30.6%, 46.9% and 66.7%, respectively, and lymph node metastasis ratios were 5.4%, 11.0% and 21.1%, respectively. Lymph node metastasis rate and lymph node metastasis ratio in patients with different tumor length had significant differences (P<0.05 for all). Lymph node metastasis ratio was 11.6% in the Chr-A negative and weak positive group, much higher than 4.3% in the Chr-A positive group (P=0.013). There was a tendency that lymph node metastasis ratio of NSE-positive group was higher than that of NSE-negative and weak positive group (P=0.069). The logistic univariate analysis did not find high risk factors of distant lymph node metastasis (all P>0.05). Logistic multivariate analysis found that only depth of invasion was a risk factor of lymph node metastasis in limited PESCC (P=0.002).

CONCLUSIONSEsophagus small cell carcinomas sometimes have early lymph node metastases in many sites and distant range. The middle thoracic PESCCs tend to have extensive metastasis quite common in the upper mediastinal lymph nodes. Lower mediastinal and abdominal lymph node metastases are often seen in lower thoracic PESCCs. The depth of invasion and tumor length are main factors influencing mediastinal lymph node metastasis. The depth of invasion is an independent risk factor for lymph node metastasis.

Abdominal Cavity ; Carcinoma, Small Cell ; pathology ; secondary ; Esophageal Neoplasms ; pathology ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mediastinum ; Multivariate Analysis ; Neoplasm Invasiveness ; Risk Factors

OBJECTIVEPaclitaxel was used in a phase II trial in combination with cisplatin for esophageal cancer. The anti-tumor response, toxicity and survival of the treated patients were evaluated.

METHODSThirty patients with advanced, unresectable, or complicated with metastasis were allotted, twenty-seven patients had no prior chemotherapy while 3 patients had received adjuvant chemotherapy. Patients were given paclitaxel 175 mg/m(2) by 3-hour infusion on D1, and cisplatin 40 mg/m(2) daily on D2 and D3. Granulocyte colony-stimulating factor (G-CSF) was not routinely administered unless the patient had neutropenia. Treatment was recycled every 21 days.

RESULTSThirty patients (male/female, 28/2; median age 58) completed a median of 3 cycles and 27 patients were evaluable for response. Major objective responses were observed in 16 patients (59.3%; 95% confidence interval, 38.9% to 75.5%), including 5 complete responses (18.5%) and 11 partial responses (40.7%). The median time to tumor progression was 5.0 months (range, 1 to 23 months). The median actuarial survival was 9.7 months (range, 1 to 23 months). Twenty-eight patients were assessable for toxicity. The most common nonhematologic toxicity was alopecia. Grade 3 to 4 neutropenia was observed in 17.9% of the patients. Toxicity was manageable with dose attenuation and G-CSF support.

CONCLUSIONThe combination of paclitaxel and cisplatin can be considered as a main regimen in the treatment of advanced esophageal cancer.

Adult ; Aged ; Alopecia ; chemically induced ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; secondary ; Cisplatin ; administration & dosage ; adverse effects ; Drug Administration Schedule ; Esophageal Neoplasms ; drug therapy ; pathology ; Female ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Lung Neoplasms ; drug therapy ; secondary ; Male ; Middle Aged ; Neoplasm Staging ; Neutropenia ; chemically induced ; Paclitaxel ; administration & dosage ; adverse effects ; Remission Induction ; Survival Rate