Eleven synchronous/metachronous primary carcinomas of the upper gastrointestinal tract: a case report

Abstract

In this paper, we report a patient with eleven synchronous/metachronous carcinomas in the upper gastrointestinal (UGI)tract treated successfully for five years. A 65-year-old male with a history of heavy smoking first visited our hospital withabnormal stomach findings by UGI endoscopy. The patient was a heavy drinker and often showed facial flushing in hisyounger years after drinking a glass of beer; thus, it was hypothesized that he had inactive heterogeneous aldehydedehydrogenase 2 alleles. Biopsy revealed the existence of adenocarcinoma of the stomach and endoscopic submucosaldissection (ESD) was subsequently performed. During the operation, three more cancers were found: two in the esophagusand one in the left pyriform sinus. Esophageal lesions were removed simultaneously by ESD. Endoscopic mucosalresection of a hypopharyngeal carcinoma using a curved rigid esophagoscope was performed one month followingdiagnosis. At the subsequent follow-up, metachronous squamous cell carcinomas in the right pyriform sinus (fifth),posterior wall of oropharynx (sixth), oral floor (seventh), esophagus (eighth and ninth), posterior wall of hypopharynx(tenth), and soft palate (eleventh) were detected. All lesions were pathologically and endoscopically independent andsuccessfully removed using an endoscopic or transoral technique. The patient is currently alive with no evidence ofdisease.