case_images: PMC11769823_01
case_images: (A, B) Pre-treatment CT image (right aortic arch and esophageal tumor). (C) Microscopic image of esophageal squamous cell carcinoma. (D) PD-L1 expression results.
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case_images: Endoscopic evaluation revealed an esophageal mass 23-28cm from the incisors, with histopathology confirming esophageal squamous cell carcinoma ( Figure 1C ). Endoscopic ultrasound indicated tumor invasion into the esophageal adventitia, and staging computed tomography (CT) demonstrated a rare congenital vascular anomaly, right aortic arch (RAA), complicating the tumor's location in the mid-upper thoracic esophagus ( Figures 1A, B ). Considering the tumor's high programmed death-ligand 1 (PD-L1) expression (CPS 50,  Figure 1D ), which is predictive of a favorable response to immunotherapy, the MDT elected to pursue neoadjuvant immunotherapy with the PD-1 inhibitor sintilimab (200 mg every three weeks).
case_images: (A) Image of esophageal tumor under endoscopic ultrasound. (B, C) Comparison of esophageal tumor on CT images before and after neoadjuvant therapy.
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case_images: Follow-up imaging, including CT and positron emission tomography-computed tomography (PET-CT), showed marked tumor regression with no signs of lymph node involvement or distant metastasis ( Figures 2A-C ).
case_images: 3D reconstruction (A, B) and intraoperative guidance (C) of the right aortic arch and esophageal tumor.
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case_images: This model allowed for precise visualization of the tumor's proximity to the right aortic arch and the left subclavian artery, which crossed above the esophagus ( Figures 3A, B ). Intraoperative findings confirmed the presence of the anomalous vascular anatomy, specifically the left subclavian artery originating from the right aortic arch and crossing anterior to the esophagus ( Figure 3C ).