Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2855
Peer-review started: August 21, 2015
First decision: September 9, 2015
Revised: October 13, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: March 7, 2016
Processing time: 195 Days and 17.4 Hours
A case in which implantation of esophageal squamous cell carcinoma onto a post-dissection gastric ulcer was strongly suspected is presented. A 72-year-old man with alcoholic liver cirrhosis underwent esophagogastroduodenoscopy (EGD). Esophageal cancer (EC) (Mt, 20 mm, 0-Is) and gastric cancer (GC) (antrum, 15 mm, 0-IIc) were identified. Biopsy specimens revealed moderately differentiated squamous cell carcinoma (SCC) and differentiated adenocarcinoma, respectively. The GC was resected by endoscopic submucosal dissection (ESD) [14 mm × 9 mm, type 0-IIc, tub1, pT1a(M), ly0, v0, HM(-), VM(-)]. Two months after ESD, radiation therapy was started for the EC, and an almost complete response was obtained. Nine months after the ESD, a follow-up EGD showed a submucosal tumor-like lesion with ulceration, located immediately under the post-ESD scar, and biopsy specimens showed moderately differentiated SCC. There were no similar lesions suggesting hematogenous or lymphatic metastasis in the stomach.
Core tip: A 72-year-old-man had gastric adenocarcinoma and esophageal squamous cell carcinoma (SCC); the gastric cancer was resected by endoscopic submucosal dissection (ESD), and the esophageal cancer was treated by radiation therapy two months after the ESD. The post ESD scar was found to be elevated and ulcerated during follow-up examination nine months after ESD, and the biopsy specimens showed SCC. It was strongly suspected that the lesion was the result of implantation of esophageal cancer onto the post-ESD ulcer, because the tumor was located immediately under the scar, and there were no similar lesions suggesting hematogenous or lymphatic metastasis.