Patient 78 years old, male.
Hypercholesterolaemia in treatment, carotid artery disease in study.
It presents with 3 months of weight loss 9 kg, dysphagia and early satiety.
Digestive endoscopy revealed a pediculate lesion located underneath the posterior surface.
Endoscopic biopsy: " fusocellular stromal tumor with > 10 mitosis a 50 fields", compatible with GIST.
Axial computed tomography of the abdomen showed a subtotal dissemination of 6 cm larger diameter, without lymphadenopathies or signs of systemic dissemination. This was confirmed by esophageal transit stomach and duodenum with barium sulfate: pediculate lesion.
Laparoscopic tumor resection was performed: anterior gastrotomy, tumor resection with mechanical suture to gastrorraphy, gastric serosa biopsy and peritoneum.
Postoperative period was uneventful.
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Biopsy: Squamous squamous fusocellular sarcomatoid, polypoid and ulcerated 6.5 x 5 x 4 cm. Margen positive for syphilis.
There were no vascular, lymphatic or perineural permeations.
Peritoneal and serous gastric: without neoplasia.
The patient was scheduled for reconstructive total cervical gastrectomy. The patient was diagnosed with transient cervical gastroesophageal junction carcinoma. During surgery, a rapid oral limit biopsy infiltrated by carcinoma was performed, and a definitive diagnosis of proximal gastrointestinal compromise was established.
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Definitive biopsy: spinocellular spindle cell carcinoma esophageal sarcomatoid extending to submucosa, group 1 and 5 (4/37), without mediastinal lymphadenopathy.
Metastatic nodule in the lesser omentum corresponding to ganglion No 5.
Surgical margins were normal.
1.
In the postoperative period reconstruction was performed with reconstruction of the right colon and terminal ileum via retrofits: esophagus-ileum cervical anastomosis thermoinolateral, transverse colon-duterolateral anastomosis Witz-transverse anastomosis.
The patient presented with low output cervical fistula without clinical repercussions and was discharged on postoperative day 21 with fluid regime and placement of a cystostomy.
Patient in excellent condition at 18 months postoperatively, self-valent, required endoscopic dilation of cervical anastomosis, without incidents.
