title: Coexistent multiple adenocarcinomas arising in Barrett's esophagus 23 years after total gastrectomy and esophageal small cell carcinoma.
abstract: A 69-year-old Japanese man undergoing total gastrectomy for multiple gastric ulcers at age 46 was found endoacopically to have multiple esophageal cancers in the upper, mid, and lower esophagus. Esophageal mucosa associated with tumors was replaced with columnar epithelium. He underwent total esophagectomy combined with laryngectomy, pharyngectomy, and lymph node dissection using the large bowel for reconstruction. The resected esophagus had multiple cancers, including well-differentiated adenocarcinoma, poorly differentiated adenocarcinoma, and small-cell carcinoma. Barrett's mucosa consisted mainly of specialized columnar epithelium while both junctional and fundic Barrett's epithelium was observed partially but not clearly. This case is indicative of the high and totipotential carcinogenetic risk of Barrett's epithelium and the relationship between duodenal content reflux and esophageal carcinogenesis after total gastrectomy.
authors.affiliation: Department of Oncological Science (Surgery II), Oita Medical University, Hasama-machi, Oita, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Noguchi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Takeno
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sato
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Uchida
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Daa
authors.forename: Shigeo
authors.initials: S
authors.lastname: Yokoyama
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005743:Gastrectomy; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011183:Postoperative Complications; D013276:Stomach Ulcer / Q000601:surgery; D013997:Time Factors