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• W2890165448 abstract "An 84-year-old man with a history of distal gastrectomy for the treatment of gastric cancer presented with epigastric pain and underwent esophagogastroduodenoscopy. Visualization showed a large tumor in the esophagus (Fig. 1a) and minute elevation with whitish granules in the duodenum (Fig. 1b). Narrow-band imaging with magnified endoscopy showed enlarged villous structures with white vesicles and enlarged and meandering superficial vessels without irregularity (Fig. 1c). Chromoendoscopy with crystal violet showed enlarged villi with decreased density and intervillous dyeability (Fig. 1d). These findings suggested that the lesion comprised tumorous components in the submucosa without exposure to the mucosal surface. We considered neuroendocrine tumor, lymphoma and lymphangioma in addition to metastatic tumor as differential diagnoses. No lymph or distant metastasis was detected on computed tomography (CT) or positron emission tomography-CT. In addition, such lesions in the small and large bowel were not detected with colonoscopy or video capsule endoscopy. Biopsies of both lesions histologically showed squamous cell carcinoma (SCC) (Fig. 2a,b). SCC in the duodenum was observed at the lamina propria and submucosa, accompanied by lymphatic invasion (Fig. 2c,d). The duodenal lesion was considered to be metastasis from esophageal SCC that had traveled through the lymphatic system. Following chemoradiotherapy, the lesions disappeared (Fig. 1e), and complete response continued for over 9 months. Only two cases of obvious duodenal metastasis have previously been described.1, 2 Notably, although the previously reported cases showed grossly obvious metastatic tumors and metastases to other organs, a minute metastatic lesion, corresponding to an early duodenal metastasis, with no other metastases, was detected in the present study. This is the first report describing the endoscopic features of an early duodenal metastasis from advanced esophageal SCC. The early detection of such duodenal metastasis may contribute to a successful response to chemotherapy and improved prognosis, even in patients with stage IV cancer. We are grateful to Dr Yu Kobayashi, Dr Takuya Iwama, Dr Keitaro Takahashi, Dr Nobuhiro Ueno, Dr Shin Kashima, Dr Kentaro Moriichi, Dr Hiroki Tanabe, Dr Yusuke Mizukami, Dr Masaaki Yamashina, and Dr Hidehiro Takei for their support with the treatment and helpful discussion. Author M.F. was supported by grants or donations from OLYMPUS Co., Ltd, TAIHO Pharmaceutical Co., Ltd and Bristol-Myers Company. M.F. has a leadership role at Kamui Pharma, Inc., and owns stock of the company. The funding source had no role in the design, practice or analysis of this study. Other authors declare that they have no conflicts of interest." @default.
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• W2890165448 date "2018-10-10" @default.
• W2890165448 modified "2023-09-23" @default.
• W2890165448 title "Minute duodenal metastasis in a patient with thoracic esophageal squamous cell carcinoma successfully treated with chemoradiotherapy" @default.
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• W2890165448 doi "https://doi.org/10.1111/den.13275" @default.
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