We report a rare case of peripheral neuropathy caused by Charcot-Marie-Tooth disease (CMT) in which a schwannoma of the esophagus was coincidentally found. A 41-year-old woman was found to have an ...upper mediastinal tumor, 25 mm in size, on a chest CT while undergoing an examination for CMT. Upper gastrointestinal endoscopy showed a submucosal tumor, however we were unable to give a diagnosis with an endoscopic ultrasound-guided fine-needle aspiration biopsy. Esophageal submucosal tumor resection was performed with thoracoscopic assistance. The tumor was composed of spindle cells with palisaded patterns. Immunohistochemical studies revealed the tumor cells were diffusely positive for S-100 protein and low levels of Ki-67 expression, which represents schwannoma. The patient is now being treated for CMT. Although it seems that the co-occurrence of CMT and esophageal schwannoma would be extremely rare, these could be caused by a same genetic abnormality.
A 36-year-old man with two different foci of Barrett esophageal adenocarcinoma arising in a long-segment Barrett esophagus (LSBE) and esophagogastric junction adenocarcinoma underwent thoracoscopic ...esophagectomy, hand-assisted laparoscopic proximal gastrectomy with 2-field lymph node dissection and reconstruction using a gastric tube through the posterior mediastinum. Histopathological findings of the lesions demonstrated two well-differentiated adenocarcinomas considered to have arisen from LSBE associated with dysplasia and hepatoid adenocarcinoma. Immunohistochemical analysis of mucin phenotype revealed different results for these three foci. However, we could not determine their origins by mucin immunoreactivity of the tumor surrounding the mucosa. The patient has survived with no recurrence and has been observed for 12 months after surgery. The low frequency of LSBE makes this disease difficult to characterize. We suggest, a detailed histopathological examination is essential in providing important information to understand esophagogastric junction cancer and/or Barrett esophageal carcinoma.
We report a case of bronchial necrosis after esophagectomy, treated using a percutaneous cardiopulmonary support system (PCPS). The patient was a 63-year-old man who underwent a thoracic ...esophagectomy with gastric tube reconstruction via the posterior mediastinum route for esophageal cancer. The respiratory condition worsened on postoperative day (POD) 5, following which anastomotic leakage, mediastinal abscess, and necrosis of the right membranous bronchus was diagnosed on POD 7. An emergency operation was performed under the PCPS, with the patient in a state of severe respiratory failure. The esophagogastric anastomosis was divided, and then a cervical esophageal fistula was created. The necrotic portion of the right main bronchus was covered by the omentum adhering to the gastric tube. PCPS use was continued after the operation and changed to veno-venous extracorporeal membrane oxygenation (V-V ECMO) on POD 3. The ECMO system was used until POD 7. The patient could be weaned off mechanical ventilation on POD 77 due to improvement in respiratory status accompanied by granulation of the bronchial necrosis. He was transferred to the previous hospital on POD 118. Bronchial necrosis after esophagectomy is commonly followed by a critical general condition because of concomitant severe respiratory failure ; therefore, a pump oxygenator such as the PCPS or ECMO may be useful in severe respiratory failure during the perioperative period.
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