Gastroenterologia Japonica Copyright 9 1992 by The Japanese Society of Gastroenterology
VoL 27, No. 2 Printed in Japan
A case of an undifferentiated small cell carcinoma of the esophagus with a primary abdominal mass Chizuko INADA ~, Atsushi TOYONAGA 2, Satoshi ITANO ~, Kazunori KUWANO 1, Yukihiro SANO 1, Ryuichirou MAEKAWA 1, Toshihiko KAWAHARA l, Osamu TSURUTA 2, Ei SASAKI 2, Kyuichi TANIKAWA 2, and Toshio OHBUCHI 3
1Department of Internal Medicine, Shakaihoken Tagawa Hospital, Fukuoka, Japan; and 2Second Department of Internal Medicine and 3First Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
Summary: This paper reports a case with an undifferentiated carcinoma of the esophagus which primarily developed symptoms due to metastatic lesions. The case was a 59-year-old woman with a primary manifestation of an abdominal mass and with subsequent dysphagia. A protruding lesion with ulceration was found at the lower third of the thoracic esophagus by endoscopic examination and was histologically proved to be an undifferentiated carcinoma by biopsy. The abdominal mass was initially thought to be due to metastasis to an abdominal lymph node based on the diagnosis image finding at admission, but it was consequently found by autopsy to be a metastatic tumor in the liver. Therefore, undifferentiated carcinoma of the esophagus should be take into account for differential diagnosis of an abdominal mass. Gastroenterol Jpn' 1992;27:234-239. Key words:
abdominal mass; liver metastasis," small cell carcinoma of the esophagus; undifferentiated cell carcinoma of the esophagus;
Introduction Undifferentiated carcinomas of the esophagus are rarely reported. A total of only 42 cases of undifferentiated carcinomas of the esophagus were reported until 1990 in Japan ~-14. We recently experienced a case of a primary undifferentiated carcinoma of the esophagus which was detected as a result of symptoms of due to metastatic tumor.
Case Report A 59-year-old woman developed abdominal pain, anorexia and body weight loss in D e c e m b e r 1988, then noticed an abdominal mass and visited a local doctor in January, 1989, but no notable abnormality was found by X-ray examination of the esophagus. However, she noticed rapid en-
largement of the abdominal mass and intensification of pain, and also dysphagia. She then visited our department and was hospitalized in. February, 1989. On admission, three lymph nodes were palpable at the left clavicular fossa. These nodes were hard, immobile, 7-10 m m in diameter and the patinut experimed no tenderness. The liver was not palpable, but a mass with a diameter of about 7 cm, which was slightly hard and caused spontaneous pain, was noted at the left hypochondrial area. Biochemical tests showed the following; L D H 1175u, Z T T 16.0u, C R P 2+, and the sedimentation rate 48 m m / h . Carcinoembryonic antigen 12.3 ng/ml (normal
VoL 27, No. 2 Printed in Japan
A case of an undifferentiated small cell carcinoma of the esophagus with a primary abdominal mass Chizuko INADA ~, Atsushi TOYONAGA 2, Satoshi ITANO ~, Kazunori KUWANO 1, Yukihiro SANO 1, Ryuichirou MAEKAWA 1, Toshihiko KAWAHARA l, Osamu TSURUTA 2, Ei SASAKI 2, Kyuichi TANIKAWA 2, and Toshio OHBUCHI 3
1Department of Internal Medicine, Shakaihoken Tagawa Hospital, Fukuoka, Japan; and 2Second Department of Internal Medicine and 3First Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
Summary: This paper reports a case with an undifferentiated carcinoma of the esophagus which primarily developed symptoms due to metastatic lesions. The case was a 59-year-old woman with a primary manifestation of an abdominal mass and with subsequent dysphagia. A protruding lesion with ulceration was found at the lower third of the thoracic esophagus by endoscopic examination and was histologically proved to be an undifferentiated carcinoma by biopsy. The abdominal mass was initially thought to be due to metastasis to an abdominal lymph node based on the diagnosis image finding at admission, but it was consequently found by autopsy to be a metastatic tumor in the liver. Therefore, undifferentiated carcinoma of the esophagus should be take into account for differential diagnosis of an abdominal mass. Gastroenterol Jpn' 1992;27:234-239. Key words:
abdominal mass; liver metastasis," small cell carcinoma of the esophagus; undifferentiated cell carcinoma of the esophagus;
Introduction Undifferentiated carcinomas of the esophagus are rarely reported. A total of only 42 cases of undifferentiated carcinomas of the esophagus were reported until 1990 in Japan ~-14. We recently experienced a case of a primary undifferentiated carcinoma of the esophagus which was detected as a result of symptoms of due to metastatic tumor.
Case Report A 59-year-old woman developed abdominal pain, anorexia and body weight loss in D e c e m b e r 1988, then noticed an abdominal mass and visited a local doctor in January, 1989, but no notable abnormality was found by X-ray examination of the esophagus. However, she noticed rapid en-
largement of the abdominal mass and intensification of pain, and also dysphagia. She then visited our department and was hospitalized in. February, 1989. On admission, three lymph nodes were palpable at the left clavicular fossa. These nodes were hard, immobile, 7-10 m m in diameter and the patinut experimed no tenderness. The liver was not palpable, but a mass with a diameter of about 7 cm, which was slightly hard and caused spontaneous pain, was noted at the left hypochondrial area. Biochemical tests showed the following; L D H 1175u, Z T T 16.0u, C R P 2+, and the sedimentation rate 48 m m / h . Carcinoembryonic antigen 12.3 ng/ml (normal
