case_images: PMC10012991_01
case_images: (a, b) Thoracic CT and (c, d) PET-CT showing a diffuse malignant lesion in the middle part of the esophagus and 20 mm x25 mm malignant nodular lesion in lower lobe of the right lung; adenosquamous carcinoma, (e) lung, x200, TTF1, squamous cell carcinoma, esophagus, (f) H&E, x200. PET-CT: Positron emission tomography-computed tomography; TTF1: Thyroid transcription factor-1.
case_images: TJTCS-2023-31-1-136-142-F1.jpg
case_images: PMC10012991_01_TJTCS-2023-31-1-136-142-F1.jpg
case_images: F1
case_images: The histopathological examination result was reported as a well-differentiated squamous cell carcinoma (Figure 1a-f). Computed tomography (CT) of the thorax detected a diffuse lesion of malignant appearance extending to the paraesophageal and subcarinal fatty tissue in the middle part of the esophagus approximately 5 cm in the segment, reaching up to 15 mm in thickness; alveolar densities and calcific nodules with chronic sequelae bilaterally in the lung parenchyma due to previous tuberculosis; and a 20x25 mm malignant nodular lesion with irregular borders in the anterior of the lower lobe of the right lung (Figure 1a, b). In addition, fluorodeoxyglucose positron emission tomography (FDG-PET) imaging showed a hypermetabolic focus in the right supraclavicular area (maximum standardized uptake value [SUVmax]: 3.98); a hypermetabolic mass lesion in the esophagus starting from the carina level and continuing as a concentric wall thickening in a 55 mm segment on the coronal axis (SUVmax: 11.20); diffuse, calcific, FDG-negative tuberculous sequela lesions bilaterally in the lung parenchyma and mediastinum; a hypermetabolic parenchymal nodular lesion with lobulated contours in the anterobasal segment of the lower lobe of the right lung showing heterogeneous metabolic activity (late SUVmax: 9.99) (Figure 1c, d).  The supraclavicular lymph node biopsy was negative for malignancy, but an adenosquamous cell carcinoma was revealed in the TTAB of the mass in right lower lobe. The histopathological examination was reported as revealed an adenosquamous cell carcinoma (Figure 1e).
case_images: PMC10012991_02
case_images: Thoracoabdominal CT showing a pleural-based 35x23 mm mass in posterior segment of the right lung upper lobe and a malignant mass on the small curvatural surface of the esophagocardiac junction and proximal part of the corpus; adenocarcinoma, lung, (c) x200; TTF1, adenocarcinoma, cardia, (d) H&E, x200.
  CT: Computed tomography; TTF1: Thyroid transcription factor-1.
case_images: TJTCS-2023-31-1-136-142-F2.jpg
case_images: PMC10012991_02_TJTCS-2023-31-1-136-142-F2.jpg
case_images: F2
case_images: In the periesophageal area, there were four to five round-shaped lymph nodes, the largest of which was 11 mm in diameter, adjacent to the esophagogastric junction, cardiac and left gastric curvature (Figure 2a, b). Postoperative histopathological examination confirmed the diagnosis of adenocarcinoma (Figure 2c, d), with associated perineural and lymphovascular invasion including 11 metastatic lymph nodes (1 splenic artery lymph node, 2 at the tumor periphery, and 8 at the small curvature) (T4aN2M0). Histopathological examination resulted in a diagnosis of solid pattern predominant lung adenocarcinoma (Figure 2c)+ reactive LAPs at stations 10, 4, 2, 7, and 9 (pT3N0M0).
case_images: PMC10012991_03
case_images: (a, b) Thoracic CT and (c, d) PET-CT showing a mass lesion with a 15-mm spicular extension in the left upper lobe's apicoposterior segment and thickening of the wall at the esophagus- gastroesophageal junction and spreading to the cardia and the lower curvature.
  PET-CT: Positron emission tomography-computed tomography.
case_images: TJTCS-2023-31-1-136-142-F3.jpg
case_images: PMC10012991_03_TJTCS-2023-31-1-136-142-F3.jpg
case_images: F3
case_images: The tumor in the lung was evaluated as malignant and second primary based on its radiological and activity characteristics (Figure 3a-d).