case_images: PMC11254663_01
case_images: Pre-treatment examination: gastroscopy (A, B) and histopathological manifestation after H&E staining (C).
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case_images: PMC11254663_01_fonc-14-1332314-g001.jpg
case_images: f1
case_images: Gastroscopy was performed (February 6, 2023): neoplastic growth and luminal narrowing were seen in the esophagus 23-30 cm from the incisors ( Figures 1A, B ). Gastroscopy was barely passed with poor sampling elasticity; the endoscopic diagnosis was esophageal cancer; pathological biopsy results indicated (esophageal) poorly differentiated carcinoma with a tendency to poorly differentiated squamous cell carcinoma ( Figure 1C ).
case_images: Pre-treatment examination: high-resolution computed tomography. (A1, B1) Green arrows indicate mid-esophageal occupations. (C1) Green arrow indicates an enlarged mediastinal lymph node (approximately 1.8 cm in diameter). Positron emission tomography/computed tomography examination. (A2) Green arrow shows dilated esophagus. (B2) Green arrow indicates mediastinal multiple lymph nodes with increased FDG metabolism. (C2) Green arrow indicates right paraesophageal hiatus lymph node with increased FDG metabolism, considered metastatic. (C2) Blue arrow indicates middle esophageal occupancy with increased FDG metabolism. Post-treatment examination: high-resolution computed tomography scan. (A3, B3) Green arrows indicate significantly shrunken esophageal cancer lesions compared with the previous scan (February 6, 2023). (C3) Green arrows indicate shrunken lymph nodes. FDG, fluorodeoxyglucose.
case_images: fonc-14-1332314-g002.jpg
case_images: PMC11254663_01_fonc-14-1332314-g002.jpg
case_images: f2
case_images: With further refinement of related examinations, chest enhanced CT revealed the following: 1) middle esophageal occupancy (thickening of the wall in the middle esophagus, nodular soft tissue mass shadow in the lumen, approximately 4.7 * 3.2 cm, moderate enhancement, and esophageal dilatation above it) ( Figures 2A1-B1 ) and 2) enlarged mediastinal lymph nodes (diameter of the enlarged lymph nodes was approximately 1.8 cm) ( Figure 2C1 ). PET-CT revealed the following: 1) middle esophageal occupancy with increased fluorodeoxyglucose (FDG) metabolism, considered esophageal malignant tumor [widening of the wall of the middle esophagus, narrowing of the lumen, nodular soft tissue mass shadow seen in the lumen, larger cross-section of approximately 5.0 * 3.2 cm, increased radiolucency, maximum standardized uptake value (SUV) of 43.58, and esophageal dilatation above it] ( Figure 2A ), and 2) multiple lymph nodes of the mediastinum and lymph nodes of the gastric right parietal hiatus with increased FDG metabolism, considered metastasis (mediastinum). After two cycles of neoadjuvant immunotherapy, the patient underwent imaging examinations; enhanced CT of the chest suggested that after treatment of middle esophageal cancer, the extent of the lesion was significantly reduced compared with that of the previous scan (February 6, 2023) (the wall of the middle esophagus was slightly thickened with mild enhancement, and the lumen of the tube did not show obvious narrowing); the mediastinal lymph nodes were partially reduced (slightly larger lymph node shadows, multiple flattened and long, were seen in the mediastinum) ( Figures 2A3, B3, C3 ).
case_images: Postoperative examination: postoperative histopathological manifestations of H&E staining. (A) Foam-like histiocytes. (B) Multinucleated giant cells.
case_images: fonc-14-1332314-g003.jpg
case_images: PMC11254663_01_fonc-14-1332314-g003.jpg
case_images: f3
case_images: After two cycles of neoadjuvant immunotherapy, the patient underwent imaging examinations; enhanced CT of the chest suggested that after treatment of middle esophageal cancer, the extent of the lesion was significantly reduced compared with that of the previous scan (February 6, 2023) (the wall of the middle esophagus was slightly thickened with mild enhancement, and the lumen of the tube did not show obvious narrowing); the mediastinal lymph nodes were partially reduced (slightly larger lymph node shadows, multiple flattened and long, were seen in the mediastinum) ( Figures 2A3, B3, C3 ). Postoperative pathological findings ( Figures 3A, B ) were as follows: 1) (thoracic esophagus) microscopic examination showed a large number of foam-like histiocyte hyperplasia, multinucleated giant cell reaction, epithelioid granuloma formation, lymphocytic infiltration with lymphoid hyperplasia, interstitial fibroblastic tissue hyperplasia, and localized calcium salt deposition; 2) no cancerous cells were found in the upper margins of the esophagus sample sent for examination, and the upper and lower margins of the esophagus were removed from the tissue by self-sampling; 3) two peri-esophageal lymph nodes, one lymph node of the 15th group, one lymph node of the left laryngeal reentry, and the right laryngeal reentry tissue were not found to have residual cancer cells.