Multiple gastrointestinal metastasis after endoscopic submucosal dissection for poorly differentiated gastric adenocarci
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CASE REPORT
Multiple gastrointestinal metastasis after endoscopic submucosal dissection for poorly differentiated gastric adenocarcinoma Yo Kubota1 · Chikatoshi Katada1 · Tsutomu Yoshida2 · Takuya Wada1 · Kei Hosoda3 · Shogo Kawakami4 · Kenji Ishido1 · Akinori Watanabe1 · Keishi Yamashita3 · Hiromichi Ishiyama4 · Naoki Hiki3 · Satoshi Tanabe5 · Wasaburo Koizumi1 Received: 12 February 2020 / Accepted: 29 May 2020 © Japanese Society of Gastroenterology 2020
Abstract A 76-year-old man had a diagnosis of double primary cancers consisting of poorly differentiated esophageal squamous cell carcinoma (ESCC) invading the submucosa and poorly differentiated gastric adenocarcinoma (GAC) invading the submucosa. The clinical stage of both ESCC and GAC was T1N0M0 stage I. The tumor diameter of ESCC and GAC was 20 mm and 25 mm, respectively. We performed chemoradiotherapy for ESCC. Chemotherapy consisted of nedaplatin in an intravenous dose of 90 mg/m2 on day 1 and 5-fluorouracil in an intravenous dose of 800 mg/m2 on days 1–5, repeated every 4 weeks for two cycles. Radiotherapy consisted of 50.4 Gy in 28 fractions for ESCC. GAC was down-staged after chemoradiotherapy for ESCC and was treated by endoscopic submucosal dissection (ESD). The tumor was histopathologically confirmed to be down-staged to intramucosal cancer with a diameter of 18 mm and no evidence of lymphovascular invasion and ulceration. Multiple metastasis occurred in the stomach, the small intestine and the colorectum after ESD. ESD is not a curative treatment even if chemotherapy is effective for poorly differentiated GAC invading the submucosa. Multiple gastrointestinal metastasis may be a unique recurrence pattern after ESD for such a lesion. Keywords Gastric cancer · Esophageal cancer · Chemotherapy · Endoscopic resection · Gastrointestinal metastasis
Introduction
* Chikatoshi Katada [email protected]‑u.ac.jp 1
Department of Gastroenterology, Kitasato University School of Medicine, 1‑15‑1 Kitasato, Minami‑ku, Sagamihara, Kanagawa 252‑0374, Japan
2
Department of Pathology, Kitasato University School of Medicine, 1‑15‑1 Kitasato, Minami, Sagamihara, Kanagawa 252‑0374, Japan
3
Department of Gastrointestinal Surgery, Kitasato University School of Medicine, 1‑15‑1 Kitasato, Minami, Sagamihara, Kanagawa 252‑0374, Japan
4
Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1‑15‑1 Kitasato, Minami, Sagamihara, Kanagawa 252‑0374, Japan
5
Department of Advanced Medicine Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1‑15‑1 Kitasato, Minami, Sagamihara, Kanagawa 252‑0374, Japan
Patients with esophageal squamous cell carcinoma (ESCC) often have double primary cancers arising in organs other than esophagus. Gastric adenocarcinoma (GAC) is most common double primary cancer [1]. The standard treatment of ESCC invading the submucosa is surgical resection (SR) [2]. Chemoradiotherapy and endoscopic submucosal dissection (ESD) followed by adjuvant chemoradiot
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