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Wojcik N.,Szpital Specjalistyczny Szczecin Zdunowo | Wojcik J.,Oddziall Kliniczny Chirurgii Klatki Piersiowej Pomorskiego | Grodzki T.,Oddziall Kliniczny Chirurgii Klatki Piersiowej Pomorskiego | Kubisa B.,Oddziall Kliniczny Chirurgii Klatki Piersiowej Pomorskiego | And 3 more authors.
Kardiochirurgia i Torakochirurgia Polska | Year: 2011

A case of 67 year-old woman with solid food dysphagia and recently revealed renal insufficiency is described. Parenteral nutrition as well as pharmacologic treatment of the renal insufficiency resulted in improvement of metabolic status and kidney function parameters. Computed tomography of the thorax with barium contrast examination of the esophagus revealed solitary esophageal infiltration with 4 millimeters stenosis that was seen at the distance of 25 centimeters from the teeth with no signs of mediastinal involvement by the tumor. Gastroscopy and EUS examination was not possible below the stenosis with 2 attempts of taking tissue samples. Bronchoscopy revealed no signs of involvement of the bronchial tree by the tumor. It was decided not to perform EBUS and to operate with intraoperative frozen section. Intraoperatively squamous cell cancer of the esophagus was confirmed and the second cancer of the third lower part of the esophagus with mediastinal infiltration was found surprisingly during surgery. The McKeown esophageal resection had been performed. Postoperative adjuvant radiotherapy was planned, however, the patient died on the tenth postoperative day due to respiratory and circulatory insufficiency as well as recurrent kidney failure. Difficulties with assessment of the esophagus below the stenosis and role of PET in preoperative examination were discussed.

Wojcik J.,Szpital Specjalistyczny Szczecin Zdunowo | Grodzki T.,Szpital Specjalistyczny Szczecin Zdunowo | Kubisa B.,Szpital Specjalistyczny Szczecin Zdunowo | Pierog J.,Szpital Specjalistyczny Szczecin Zdunowo | And 2 more authors.
Kardiochirurgia i Torakochirurgia Polska | Year: 2012

We present a case of 58 year-old patient with solid food dysphagia due to neoplastic infiltration of the esophagus 37 centimeters from the incisors and 10 kilograms body weight loss. Computed tomography revealed abnormal 20 mm thickness of the esophagus wall up to 5 cm above the cardia as well as enlarged 15 mm pericardial lymph node suspected of metastatic etiology. Diagnosis of adenocarcinoma was confirmed endoscopically. Gastroscopy and endoscopic ultrasound (EUS) examination were not possible to perform below the level of the esophageal infiltration stenosis. Bronchofiberoscopy revealed no pathological findings. The patient was treated by parenteral nutrition for 10 days prior to surgery. Ivory-Lewis esophageal resection was performed with two-field lymphadenectomy and thoracic duct resection. A tumor 1 cm in diameter located in the upper right lobe not found on chest computed tomography (CT) was palpated at the time of the surgery. It was decided to perform additional right upper lobectomy. Histopathological specimen examination confirmed primary synchronous small cell lung cancer. The role of PET examination in preoperative diagnosis of patients with esophageal cancer is discussed below.

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