NEWLY DEVELOPED CARCINOMA ON THE RECONSTRUCTED GASTRIC TUBE AFTER PREVIOUS OPERATION FOR ESOPHAGEAL AND GASTRIC CANCER

Abstract

Reports of double cancer of esophageal cancer and a cancer of other organ are relatively common, and sometimes we see case reports of gastric cancer arising in the reconstructed gastric tube following an operation for primary esophageal cancer in the literature. In this paper a case of carcinoma developed in the reconstructed gastric tube four years after operation for esophageal and gastric cancers in a 69-year-old man is presented. When the patient was 65 years old, he was admitted to the hospital because of dysphagic. Radiographic and endoscopic studies revealed an ulcerative and localized type tumor (type II of Borrmann's classification) in the mid esophagus and a superficial type of early gastric cancer (IIc type) in the upper porition of the stomach. Subtotal esophagectomy and partial gastrectomy with lymph node dissection were performed, followed by reconstruction with a gastric tube through ante-thoracic routes. Pathological findings on the excised specimen showed well differentiated squamous cell carcinoma invaded the adventitia of the esophagus with lymph node metastasis in the mid portion of the esophagus and well differentiated tubular adenocarcinoma confined to the submucosal layer without lymph node metastasis in the lesser curvature of the stomach. Four years after the operation, two superficial type lesions (IIc and IIa+IIc type) were observed in the reconstructed gastric tube on his periodic endoscopic examination. The lesions were diagnosed as adenocarcinoma on biopsy specimens. Lower one third of the gastric tube was safely resected for two lesions, followed by reconstruction of the remnant gastric tube with jejunum in Rouxen Y type anastomosis. On excised specimen of the gastric tube two superficial type lesions were present and diagnosed as early gastric cancer. All three lesions in the stomach were consisted of early gastric cancer (one mucosal and two submucosal tumors), histologically same, negative lymph node and being separated distinctly by normal gastric wall each other, whereas one lesion mild vessel invasion was presented. Finally they were diagnosed as multiple gastric cancers. The patient is still alive and well as of 5 years after the initial operation. Periodic endoscopic examination disclosed carcinoma on the reconstructed gastric tube with an advisable reoperative prognosis.