Novel use of Weerda laryngoscope to remove early cervical esophageal cancer.

A 65-year-old man was followed up after endoscopic mucosal resection for esophageal cancer in February 2000. Thereafter, he received endoscopic mucosal resection, radiation therapy, and argon plasma coagulation for recurrent and multiple primary esophageal cancers. On follow-up examination, two additional esophageal cancers were detected by endoscopy in September 2003. One lesion was located 16 cm from the incisor close to the entrance to the esophagus. To preserve the larynx, this lesion was removed by mucosal resection using a Weerda distending operating laryngoscope. This report describes this novel use of a Weerda distending operating laryngoscope to remove superficial cervical esophageal cancer.

Co-existence of early esophageal carcinoma and leiomyoma: a case report.

There have been several reports of co-existing esophageal squamous cell carcinoma and esophageal submucosal tumor. However, there is no previous report describing a submucosal tumor located within an area of early esophageal cancer. This report presents the case of a 64-year-old man who developed early esophageal cancer with leiomyoma situated within the lesion in the upper third of the esophagus. Since leiomyoma existed within the area of the esophageal cancer, it was misdiagnosed as a component of esophageal cancer and the depth of esophageal cancer invasion was overdiagnosed by endoscopic ultrasonography. Therefore, surgery was chosen as treatment for esophageal cancer. If the leiomyoma had been diagnosed correctly as a submucosal tumor by endoscopy and endoscopic ultrasonography, an endoscopic mucosal resection would have been the therapeutic procedure of choice for an esophageal tumor.

Submucosal territory of the direct lymphatic drainage system to the thoracic duct in the human esophagus.

OBJECTIVE: To investigate how large submucosal drainage territory extends in lymphatic drainage vessels of the esophagus with and without nodal delay and which morphologies are shown when passing through the muscularis propria. METHODS: Submucosal territories of the 22 highly selected direct drainage vessels of 17 esophagi were histologically examined using transverse or sagittal serial sections. Afferent vessels from the esophagus to the subcarinal (6 esophagi) and para-esophageal (5 esophagi) nodes were also examined to identify their courses and drainage territories. RESULTS: We found the direct drainage vessel from the esophagus in 17 of 75 cadavers macroscopically (22.7%). A single submucosal drainage unit gave off 1-3 thick drainage vessels passing through a complete muscle gap of the 2 muscular layers. The unit extended longitudinally for >40 mm but was restricted to the right and/or dorsal quadrants of the esophagus. In contrast, drainage routes with a nodal relay originated from the intermuscular area, except 1 case when the adjacent or concomitant esophageal artery and vein provided the complete muscle gap. CONCLUSIONS: Due to the extended longitudinal but restricted transverse territory of the direct drainage system without a nodal relay and because of the suggested much more frequent occurrence in patients than in cadavers, when superficial carcinoma is found in the dorsal and/or right quadrants of the esophagus, we recommend detailed presurgical investigations of cervical nodes. In contrast, afferents from the esophagus to the first regional node usually seemed to be less responsible for early nodal metastasis than the direct drainage route because of their intermuscular origins.