27004009 Visualization

A 65 Age - year Age - old Age man Sex was admitted Clinical_event to the China Nonbiological_location - Japan Nonbiological_location Friendship Nonbiological_location hospital Nonbiological_location with a chief complaint of progressive Detailed_description dysphagia Sign_symptom for 3 Duration mo Duration .
He also complained of a drastic Severity weight Sign_symptom loss Sign_symptom of 8 Lab_value kg Lab_value in the past Duration 2 Duration mo Duration .
He denied History a History history History of History smoking, History alcohol History intake History and History substance History abuse History , but had a chronic Detailed_description atrophic Detailed_description gastritis Disease_disorder for nearly Duration 10 Duration years Duration .
Also, there was no Family_history family Family_history history Family_history of Family_history genetic Family_history defect Family_history or Family_history malignancy Family_history .
Physical Diagnostic_procedure examination Diagnostic_procedure showed no Lab_value palpable Lab_value findings Lab_value .
Admission blood Diagnostic_procedure test Diagnostic_procedure showed a slight Lab_value decrease Lab_value in hemoglobin Diagnostic_procedure ( 106 Lab_value g/L Lab_value ).
Upper Biological_structure gastrointestinal Biological_structure ( GI Biological_structure ) examination Diagnostic_procedure using barium Detailed_description contrasts Detailed_description showed a large Severity tumor Sign_symptom blocking Sign_symptom the esophago Biological_structure - gastric Biological_structure junction Biological_structure (Figure ​1).
Computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan revealed a soft Texture mass Sign_symptom in the esophago Biological_structure - gastric Biological_structure junction Biological_structure with lymph Biological_structure node Biological_structure metastasis Sign_symptom in the lesser Biological_structure curvature Biological_structure of Biological_structure the Biological_structure stomach Biological_structure (Figure ​2).
Endoscopic Diagnostic_procedure examination Diagnostic_procedure showed a black Color spot Sign_symptom in the lower Biological_structure esophagus Biological_structure and a bulky Detailed_description black Color mass Sign_symptom blocking Sign_symptom the esophago Biological_structure - gastric Biological_structure junction Biological_structure , as well as two Detailed_description black Color crater Shape - like Shape ulcers Sign_symptom in the fundus Biological_structure of Biological_structure the Biological_structure stomach Biological_structure (Figure ​3).
Biopsy Diagnostic_procedure specimens taken from the tumor Sign_symptom were identified as poorly Detailed_description differentiated Detailed_description adenocarcinoma Disease_disorder .
Preoperative nutrition Diagnostic_procedure status Diagnostic_procedure of this case was scored 2 Lab_value based on the Nutrition Detailed_description Risk Detailed_description Screening Detailed_description 2002 Detailed_description (NRS 2002)[6].
Because of the obstructive Coreference symptom Coreference caused by the tumor Coreference , a debulking Therapeutic_procedure surgery Therapeutic_procedure of distal Detailed_description esophagectomy Therapeutic_procedure and proximal Detailed_description gastrectomy Therapeutic_procedure was performed.
Esophagogastric Biological_structure anastomosis Therapeutic_procedure and reconstruction Therapeutic_procedure was then completed with stapling Therapeutic_procedure device Therapeutic_procedure .
Intraoperatively, the tumor Sign_symptom was found located at the esophago Biological_structure - gastric Biological_structure junction Biological_structure and the tumor Coreference infiltrated Sign_symptom the whole Biological_structure layer Biological_structure with lymph Biological_structure node Biological_structure metastasis Sign_symptom at station Biological_structure four Biological_structure .
No ascites Sign_symptom or dissemination Sign_symptom of Sign_symptom the Sign_symptom tumor Sign_symptom was observed in the peritoneal Biological_structure cavity Biological_structure .
The tumor Sign_symptom measured 3 Area cm Area × Area 6 Area cm Area in size with black Color pigmentation Color (Figure ​4).
There were several Detailed_description pigmented Color satellite Detailed_description nodules Sign_symptom beside the main Coreference tumor Coreference lesion Coreference , the largest Coreference one Coreference being 1 Area cm Area × Area 1 Area cm Area in diameter.
Moreover, two ulceration Detailed_description lesions Sign_symptom were found at the fundus Biological_structure of Biological_structure the Biological_structure stomach Biological_structure .
Microscopically Diagnostic_procedure , the excised tumor Biological_structure tissue Biological_structure was composed of non Lab_value - organized Lab_value and pleomorphic Lab_value cells Diagnostic_procedure exhibiting atypical Lab_value nuclei Diagnostic_procedure , and abundant Lab_value melanin Diagnostic_procedure granules Diagnostic_procedure (Figure ​5).
Pathological Diagnostic_procedure examination Diagnostic_procedure identified this case at a stage Diagnostic_procedure of IVA Lab_value ( T4aN1M0 Lab_value ).
Immunohistochemical Diagnostic_procedure staining Diagnostic_procedure showed that the tumor Coreference was positive Lab_value for S-100, HMB-45, mclean Diagnostic_procedure - A Diagnostic_procedure and Vimentin Diagnostic_procedure , but negative Lab_value for cytokeratin Diagnostic_procedure 7 Diagnostic_procedure and cytokeratin Diagnostic_procedure 20 Diagnostic_procedure (Figure ​6).
Based on these results, a diagnosis of primary Detailed_description advanced Severity esophago Detailed_description - gastric Detailed_description melanoma Disease_disorder was established.
The postoperative Therapeutic_procedure course Therapeutic_procedure was smooth Lab_value and without complications Sign_symptom .
The patient gradually recovered Sign_symptom and was discharged Clinical_event 14 Date d Date after Date surgery.
As the patient denied a postoperative adjuvant Medication therapy Medication , abdominal Biological_structure recurrence Sign_symptom and hepatic Biological_structure metastases Sign_symptom were found within Date one Date month Date by a postoperative follow Clinical_event - up Clinical_event CT Diagnostic_procedure .
No other Therapeutic_procedure effective Therapeutic_procedure treatment Therapeutic_procedure was administered afterwards.
The patient died Outcome of diffuse Detailed_description metastatic Disease_disorder disease Disease_disorder 2 Date mo Date later Date .