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T1 Age 2 13 63-year-old T2 Sex 14 18 male T3 History 27 62 without smoking or drinking history T4 Date 76 92 on June 11, 2014 E1 Date:T4 T5 Clinical_event 67 75 admitted E2 Clinical_event:T5 R1 MODIFY Arg1:E1 Arg2:E2 T6 Sign_symptom 141 150 dysphagia E3 Sign_symptom:T6 T7 Sign_symptom 155 162 fatigue E4 Sign_symptom:T7 T8 Disease_disorder 180 199 obstructive disease E5 Disease_disorder:T8 A1 POLARITY E5 UNCERTAIN T9 Occupation 229 248 had been an athlete T10 Biological_structure 203 224 upper digestive tract R2 MODIFY Arg1:T10 Arg2:E5 T11 History 266 297 retired in good physical status T12 History 316 372 His family and social history indicated nothing abnormal T13 Diagnostic_procedure 383 403 physical examination E6 Diagnostic_procedure:T13 T14 Biological_structure 411 415 skin T15 Biological_structure 417 428 oral mucosa T16 Biological_structure 430 434 eyes T17 Biological_structure 440 453 genital areas R3 MODIFY Arg1:T14 Arg2:E6 R4 MODIFY Arg1:T15 Arg2:E6 R5 MODIFY Arg1:T16 Arg2:E6 R6 MODIFY Arg1:T17 Arg2:E6 T18 Sign_symptom 489 496 lesions E7 Sign_symptom:T18 A2 POLARITY E7 NEG T19 Diagnostic_procedure 512 528 laboratory tests E8 Diagnostic_procedure:T19 T20 Diagnostic_procedure 539 555 hepatic function E9 Diagnostic_procedure:T20 T21 Diagnostic_procedure 557 571 renal function E10 Diagnostic_procedure:T21 T22 Diagnostic_procedure 577 596 serum tumor markers E11 Diagnostic_procedure:T22 T23 Diagnostic_procedure 605 629 carcinoembryonic antigen E12 Diagnostic_procedure:T23 T24 Diagnostic_procedure 631 654 cytokeratin 19 fragment E13 Diagnostic_procedure:T24 T25 Diagnostic_procedure 656 679 squamous cell carcinoma E14 Diagnostic_procedure:T25 T26 Diagnostic_procedure 681 704 neuron-specific enolase E15 Diagnostic_procedure:T26 T27 Diagnostic_procedure 710 734 carbohydrate antigen 125 E16 Diagnostic_procedure:T27 R7 SUB_PROCEDURE Arg1:E9 Arg2:E8 R8 SUB_PROCEDURE Arg1:E10 Arg2:E8 R9 SUB_PROCEDURE Arg1:E11 Arg2:E8 R10 SUB_PROCEDURE Arg1:E12 Arg2:E11 R11 SUB_PROCEDURE Arg1:E13 Arg2:E11 R12 SUB_PROCEDURE Arg1:E14 Arg2:E11 R13 SUB_PROCEDURE Arg1:E15 Arg2:E11 R14 SUB_PROCEDURE Arg1:E16 Arg2:E11 T28 Lab_value 744 759 in normal range R15 MODIFY Arg1:T28 Arg2:E16 R16 MODIFY Arg1:T28 Arg2:E15 R17 MODIFY Arg1:T28 Arg2:E14 R18 MODIFY Arg1:T28 Arg2:E13 R19 MODIFY Arg1:T28 Arg2:E12 R20 MODIFY Arg1:T28 Arg2:E10 R21 MODIFY Arg1:T28 Arg2:E9 T29 Diagnostic_procedure 808 820 examinations E17 Diagnostic_procedure:T29 T30 Detailed_description 795 807 radiological T31 Detailed_description 780 790 endoscopic R22 MODIFY Arg1:T30 Arg2:E17 R23 MODIFY Arg1:T31 Arg2:E17 T32 Diagnostic_procedure 862 884 Endoscopic examination E18 Diagnostic_procedure:T32 T33 Sign_symptom 926 930 mass E19 Sign_symptom:T33 T34 Detailed_description 916 925 irregular T35 Color 896 914 slightly pigmented R24 MODIFY Arg1:T34 Arg2:E19 R25 MODIFY Arg1:T35 Arg2:E19 T36 Biological_structure 953 968 lower esophagus R26 MODIFY Arg1:T36 Arg2:E19 T37 Area 980 995 5.0 cm × 3.0 cm R27 MODIFY Arg1:T37 Arg2:E19 T38 Diagnostic_procedure 1017 1023 biopsy E20 Diagnostic_procedure:T38 T39 Detailed_description 1005 1016 Fine needle R28 MODIFY Arg1:T39 Arg2:E20 T40 Coreference 1031 1037 lesion E21 Coreference:T40 R29 IDENTICAL Arg1:E21 Arg2:E19 R30 MODIFY Arg1:E21 Arg2:E20 T41 Disease_disorder 1058 1066 melanoma E22 Disease_disorder:T41 T42 Biological_structure 1047 1057 esophageal R31 MODIFY Arg1:T42 Arg2:E22 T43 Diagnostic_procedure 1091 1105 histopathology E23 Diagnostic_procedure:T43 T44 Diagnostic_procedure 1133 1152 computed tomography E24 Diagnostic_procedure:T44 T45 Diagnostic_procedure 1154 1156 CT E25 Diagnostic_procedure:T45 R32 IDENTICAL Arg1:E25 Arg2:E24 T46 Biological_structure 1125 1132 abdomen T47 Biological_structure 1115 1120 chest R33 MODIFY Arg1:T46 Arg2:E24 R34 MODIFY Arg1:T47 Arg2:E24 T48 Diagnostic_procedure 1176 1200 magnetic resonance image E26 Diagnostic_procedure:T48 T49 Biological_structure 1168 1175 cranial T50 Detailed_description 1159 1167 enhanced R35 MODIFY Arg1:T50 Arg2:E26 R36 MODIFY Arg1:T49 Arg2:E26 T51 Diagnostic_procedure 1202 1205 MRI E27 Diagnostic_procedure:T51 R37 IDENTICAL Arg1:E27 Arg2:E26 T52 Diagnostic_procedure 1216 1244 emission computed tomography E28 Diagnostic_procedure:T52 T53 Diagnostic_procedure 1246 1249 ECT E29 Diagnostic_procedure:T53 R38 IDENTICAL Arg1:E29 Arg2:E28 T54 Biological_structure 1211 1215 bone R39 MODIFY Arg1:T54 Arg2:E28 T55 Sign_symptom 1258 1266 enlarged E30 Sign_symptom:T55 T56 Biological_structure 1295 1306 lymph nodes R40 MODIFY Arg1:T56 Arg2:E30 T57 Biological_structure 1267 1278 mediastinal T58 Biological_structure 1288 1294 celiac R41 MODIFY Arg1:T58 Arg2:T56 R42 MODIFY Arg1:T57 Arg2:T56 T59 Sign_symptom 1333 1344 involvement E31 Sign_symptom:T59 A3 POLARITY E31 MAYBE_NEG T60 Biological_structure 1364 1375 lymph nodes T61 Biological_structure 1348 1363 supraclavicular R43 MODIFY Arg1:T61 Arg2:T60 R44 MODIFY Arg1:T60 Arg2:E31 T62 Diagnostic_procedure 1395 1397 CT E32 Diagnostic_procedure:T62 T63 Sign_symptom 1438 1443 tumor E33 Sign_symptom:T63 T64 Biological_structure 1428 1437 pulmonary T65 Detailed_description 1418 1427 irregular T66 Detailed_description 1408 1416 isolated R45 MODIFY Arg1:T64 Arg2:E33 R46 MODIFY Arg1:T65 Arg2:E33 R47 MODIFY Arg1:T66 Arg2:E33 T67 Diagnostic_procedure 1454 1482 Positron emission tomography E34 Diagnostic_procedure:T67 A4 POLARITY E34 NEG T68 Diagnostic_procedure 1596 1613 clinically staged E35 Diagnostic_procedure:T68 T69 Lab_value 1617 1624 cT3NxM1 R48 MODIFY Arg1:T69 Arg2:E35 T70 Detailed_description 1642 1710 7th edition of American Joint Committee on Cancer TNM staging system R49 MODIFY Arg1:T70 Arg2:E35 T71 Disease_disorder 1715 1732 esophageal cancer E36 Disease_disorder:T71 T72 Diagnostic_procedure 1767 1773 biopsy E37 Diagnostic_procedure:T72 T73 Biological_structure 1757 1766 pulmonary T74 Detailed_description 1744 1756 percutaneous T75 Detailed_description 1734 1743 CT-guided R50 MODIFY Arg1:T73 Arg2:E37 R51 MODIFY Arg1:T74 Arg2:E37 R52 MODIFY Arg1:T75 Arg2:E37 T76 Therapeutic_procedure 1858 1867 resection E38 Therapeutic_procedure:T76 T77 Sign_symptom 1900 1907 lesions E39 Sign_symptom:T77 T78 Biological_structure 1875 1885 esophageal T79 Biological_structure 1890 1899 pulmonary R53 MODIFY Arg1:T79 Arg2:E39 R54 MODIFY Arg1:T78 Arg2:E39 T80 Detailed_description 1845 1857 Single-stage R55 MODIFY Arg1:T80 Arg2:E38 T81 Clinical_event 1961 1973 consultation E40 Clinical_event:T81 T82 Therapeutic_procedure 2239 2252 esophagectomy E41 Therapeutic_procedure:T82 T83 Therapeutic_procedure 2269 2278 lobectomy E42 Therapeutic_procedure:T83 T84 Therapeutic_procedure 2117 2136 targeted antibodies E43 Therapeutic_procedure:T84 A5 POLARITY E43 NEG T85 Detailed_description 2257 2268 right upper R56 MODIFY Arg1:T85 Arg2:E42 T86 Detailed_description 2228 2238 Ivor-Lewis T87 Detailed_description 2215 2227 simultaneous R57 MODIFY Arg1:T86 Arg2:E41 R58 MODIFY Arg1:T87 Arg2:E41 R59 MODIFY Arg1:T87 Arg2:E42 T88 Medication 2314 2332 general anesthesia E44 Medication:T88 T89 Therapeutic_procedure 2366 2376 intubation E45 Therapeutic_procedure:T89 T90 Detailed_description 2353 2365 endotracheal T91 Detailed_description 2340 2352 double-lumen R60 MODIFY Arg1:T90 Arg2:E45 R61 MODIFY Arg1:T91 Arg2:E45 T92 Therapeutic_procedure 2399 2409 dissection E46 Therapeutic_procedure:T92 T93 Detailed_description 2390 2398 systemic T94 Biological_structure 2413 2424 lymph nodes R62 MODIFY Arg1:T94 Arg2:E46 R63 MODIFY Arg1:T93 Arg2:E46 T95 Biological_structure 2436 2447 mediastinum T96 Biological_structure 2452 2459 abdomen R64 MODIFY Arg1:T95 Arg2:T94 R65 MODIFY Arg1:T96 Arg2:T94 T97 Duration 2542 2553 290 minutes E47 Duration:T97 T98 Sign_symptom 2571 2579 bleeding E48 Sign_symptom:T98 A6 POLARITY E48 NEG T99 Diagnostic_procedure 2614 2635 pathological staining E49 Diagnostic_procedure:T99 T100 Sign_symptom 2661 2678 pleomorphic cells E50 Sign_symptom:T100 T101 Sign_symptom 2692 2708 melanin granules E51 Sign_symptom:T101 T102 Diagnostic_procedure 2727 2752 immunohistochemical tests E52 Diagnostic_procedure:T102 T103 Diagnostic_procedure 2789 2812 human melanoma black 45 E53 Diagnostic_procedure:T103 T104 Lab_value 2766 2785 positive expression R66 MODIFY Arg1:T104 Arg2:E53 T105 Diagnostic_procedure 2814 2819 HMB45 E54 Diagnostic_procedure:T105 R67 IDENTICAL Arg1:E54 Arg2:E53 T106 Diagnostic_procedure 2822 2858 microtubule-associated protein tau 1 E55 Diagnostic_procedure:T106 T107 Diagnostic_procedure 2860 2865 MAPT1 E56 Diagnostic_procedure:T107 R68 IDENTICAL Arg1:E56 Arg2:E55 R69 MODIFY Arg1:T104 Arg2:E55 T108 Diagnostic_procedure 2868 2875 melan A E57 Diagnostic_procedure:T108 T109 Diagnostic_procedure 2880 2884 S100 E58 Diagnostic_procedure:T109 R70 MODIFY Arg1:T104 Arg2:E58 R71 MODIFY Arg1:T104 Arg2:E57 T110 Lab_value 2890 2909 negative expression T111 Diagnostic_procedure 2913 2919 desmin E59 Diagnostic_procedure:T111 T112 Diagnostic_procedure 2921 2934 synaptophysin E60 Diagnostic_procedure:T112 T113 Diagnostic_procedure 2940 2967 epithelial membrane antigen E61 Diagnostic_procedure:T113 T114 Diagnostic_procedure 2969 2972 EMA E62 Diagnostic_procedure:T114 R72 IDENTICAL Arg1:E62 Arg2:E61 R73 MODIFY Arg1:T110 Arg2:E59 R74 MODIFY Arg1:T110 Arg2:E60 R75 MODIFY Arg1:T110 Arg2:E61 T115 Disease_disorder 3001 3009 melanoma E63 Disease_disorder:T115 T116 Biological_structure 3036 3057 dissected lymph nodes T117 Biological_structure 3015 3031 resection margin T118 Sign_symptom 3078 3083 tumor E64 Sign_symptom:T118 A7 POLARITY E64 NEG R76 MODIFY Arg1:T116 Arg2:E64 R77 MODIFY Arg1:T117 Arg2:E64 T119 Diagnostic_procedure 3107 3122 molecular study E65 Diagnostic_procedure:T119 T120 Sign_symptom 3148 3206 mutation of V-raf murine sarcoma viral oncogene homolog B1 E66 Sign_symptom:T120 T121 Disease_disorder 3270 3274 PMME E67 Disease_disorder:T121 #1 AnnotatorNotes E67 primary malignant melanoma of the esophagus T122 Severity 3261 3269 advanced R78 MODIFY Arg1:T122 Arg2:E67 T123 Lab_value 3306 3314 stage IV T124 Lab_value 3316 3323 pT3N0M1 R79 MODIFY Arg1:T123 Arg2:E67 R80 MODIFY Arg1:T124 Arg2:E67 T125 Therapeutic_procedure 3458 3480 postoperative recovery E68 Therapeutic_procedure:T125 T126 Lab_value 3485 3502 mainly uneventful R81 MODIFY Arg1:T126 Arg2:E68 T127 Clinical_event 3524 3534 discharged E69 Clinical_event:T127 T128 Date 3535 3556 14 days after surgery E70 Date:T128 T129 Medication 3606 3618 chemotherapy E71 Medication:T129 T130 Sign_symptom 3712 3728 thrombocytopenia E72 Sign_symptom:T130 T131 Sign_symptom 3730 3740 leukopenia E73 Sign_symptom:T131 T132 Sign_symptom 3742 3748 nausea E74 Sign_symptom:T132 T133 Sign_symptom 3750 3758 vomiting E75 Sign_symptom:T133 T134 Sign_symptom 3764 3772 diarrhea E76 Sign_symptom:T134 T135 Dosage 3572 3580 4 cycles R82 MODIFY Arg1:T135 Arg2:E71 T136 Dosage 3624 3646 an interval of 3 weeks R83 MODIFY Arg1:T136 Arg2:E71 T137 Detailed_description 3584 3592 adjuvant T138 Detailed_description 3593 3605 conventional R84 MODIFY Arg1:T138 Arg2:E71 R85 MODIFY Arg1:T137 Arg2:E71 T139 Sign_symptom 4289 4299 leukopenia E77 Sign_symptom:T139 T140 Sign_symptom 4301 4317 myelosuppression E78 Sign_symptom:T140 T141 Severity 4280 4288 moderate R86 MODIFY Arg1:T141 Arg2:E77 R87 MODIFY Arg1:T141 Arg2:E78 T142 Medication 4348 4360 chemotherapy E79 Medication:T142 T143 Sign_symptom 4369 4378 recovered E80 Sign_symptom:T143 T144 Medication 4415 4452 granulocyte colony-stimulating factor E81 Medication:T144 T145 Medication 4454 4459 G-CSF E82 Medication:T145 R88 BEFORE Arg1:E82 Arg2:E81 T146 Medication 4488 4513 human interferon alpha-2b E83 Medication:T146 T147 Administration 4613 4633 hypodermic injection R89 MODIFY Arg1:T147 Arg2:E83 T148 Dosage 4646 4669 6000 units every 3 days R90 MODIFY Arg1:T148 Arg2:E83 T149 Duration 4687 4697 for 1 year E84 Duration:T149 T150 Clinical_event 4715 4726 followed up E85 Clinical_event:T150 T151 Diagnostic_procedure 4777 4779 CT E86 Diagnostic_procedure:T151 T152 Biological_structure 4769 4776 abdomen T153 Biological_structure 4759 4764 Chest R91 MODIFY Arg1:T152 Arg2:E86 R92 MODIFY Arg1:T153 Arg2:E86 T154 Diagnostic_procedure 4789 4792 MRI E87 Diagnostic_procedure:T154 T155 Diagnostic_procedure 4799 4802 ECT E88 Diagnostic_procedure:T155 T156 Biological_structure 4781 4788 cranial T157 Biological_structure 4794 4798 bone R93 MODIFY Arg1:T156 Arg2:E87 R94 MODIFY Arg1:T157 Arg2:E88 T158 Diagnostic_procedure 4817 4837 physical examination E89 Diagnostic_procedure:T158 T159 Frequency 4855 4869 every 3 months R95 MODIFY Arg1:T159 Arg2:E89 R96 MODIFY Arg1:T159 Arg2:E88 R97 MODIFY Arg1:T159 Arg2:E87 R98 MODIFY Arg1:T159 Arg2:E86 T160 Outcome 4898 4906 survived E90 Outcome:T160 T161 Sign_symptom 4929 4939 recurrence E91 Sign_symptom:T161 A8 POLARITY E91 NEG T162 Sign_symptom 4950 4960 metastasis E92 Sign_symptom:T162 A9 POLARITY E92 NEG T163 Detailed_description 4943 4949 remote T164 Detailed_description 4915 4928 loco-regional R99 MODIFY Arg1:T164 Arg2:E91 R100 MODIFY Arg1:T163 Arg2:E92 T165 Clinical_event 4972 4981 follow-up E93 Clinical_event:T165 T166 Duration 4985 5005 two and a half years E94 Duration:T166 T167 Medication 3823 3842 paclitaxel liposome E95 Medication:T167 T168 Administration 3847 3856 injection T169 Medication 3985 3992 tegafur E96 Medication:T169 T170 Administration 3993 4002 injection R101 MODIFY Arg1:T168 Arg2:E95 R102 MODIFY Arg1:T170 Arg2:E96 T171 Medication 4125 4137 cis-platinum E97 Medication:T171 * OVERLAP E2 E3 E4 E5 E6 E7 E8 R103 BEFORE Arg1:E8 Arg2:E17 * OVERLAP E17 E18 E19 E20 E22 E23 E24 E26 E28 E30 E31 E32 E33 E34 E35 E36 E37 A10 POLARITY E37 NEG R104 BEFORE Arg1:E37 Arg2:E38 * OVERLAP E38 E39 R105 AFTER Arg1:E39 Arg2:E40 * OVERLAP E40 E43 R106 BEFORE Arg1:E43 Arg2:E41 * OVERLAP E41 E42 E44 E45 E46 E47 E48 R107 BEFORE Arg1:E48 Arg2:E49 * OVERLAP E49 E50 E51 E52 E53 E55 E57 E58 E59 E60 E61 E63 E64 E65 E66 E67 R108 BEFORE Arg1:E67 Arg2:E68 R109 BEFORE Arg1:E68 Arg2:E69 * OVERLAP E69 E70 R110 BEFORE Arg1:E70 Arg2:E71 * OVERLAP E71 E72 E73 E74 E75 E76 E95 E96 E97 E77 E78 E79 E80 E81 E83 E84 E85 R111 CAUSE Arg1:E81 Arg2:E80 R112 MODIFY Arg1:E84 Arg2:E83 R113 BEFORE Arg1:E85 Arg2:E86 * OVERLAP E86 E87 E88 E89 R114 BEFORE Arg1:E89 Arg2:E90 * OVERLAP E90 E91 E92 E93 E94 T172 Activity 35 42 smoking E98 Activity:T172 T173 Activity 46 54 drinking E99 Activity:T173 A11 POLARITY E98 NEG A12 POLARITY E99 NEG R115 BEFORE Arg1:E99 Arg2:E2 * OVERLAP E98 E99