[A Patient with Basaloid Carcinoma of the Esophagus Removed Surgically after Pre-Operative Chemotherapy Who Developed TTP during Post-Operative Chemotherapy].

Abstract

A 63-year-old man presented with the chief complaint of an unpleasant feeling in the chest after a meal.Esophagogastroduodenoscopy revealed interminglement of ulcer infiltration type lesions and protruding lesions in the lower esophagus.A large type 1 protruding lesion was located mainly in the esophagogastric junction(EGJ)and it progressed towards the stomach.A hypertrophic and protruding lesion on the lower esophageal wall and a 6 cm tumor in the major axis of the fornix were observed on thoracic and abdominal CT, and an endocrine cell carcinoma or basaloid carcinoma were suggested after biopsy.Finally, we diagnosed a basaloid carcinoma after immunohistochemistry analysis.We administered 4 courses of TS-1 plus CDDP as pre-operative chemotherapy.Because of a significant reduction in tumor size, approximately 5 months after first presentation, we performed esophageal resection by right thoracotomy and laparotomy, and reconstructive surgery for the thoracic gastric duct.The pathological diagnosis was basaloid carcinoma with multiple foci of squamous cell carcinoma.After surgery, we continued chemotherapy with TS-1 plus CDDP, which was previously effective, but a liver metastasis appeared 8 months later.We discontinued chemotherapy because of a prominent decline in platelets.Because of the clinical symptoms, we diagnosed secondary thrombotic thrombocytopenic purpura accompanied by a malignant tumor.We implemented plasma exchange and steroid pulse therapy, but this patient experienced no therapeutic effect and died.

• Authors: Akemi Watanabe, Hiroyuki Fukunari, Yousuke Kawai, Makoto Aoki, Satoshi Saito, Yuya Umebayashi, Kenji Shitara, Tetsuji Hayashi, Gen Watanabe, Hiroshi Ajioka
• Journal: Gan to kagaku ryoho. Cancer & chemotherapy (Gan To Kagaku Ryoho) Vol. 44 Issue 12 Pg. 1110-1113 (Nov 2017) ISSN: 0385-0684 [Print] Japan
• PMID: 29394550 (Publication Type: Case Reports, Journal Article)

Chemical References

• Silicates
• titanium silicide
• Titanium
• Cisplatin

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Squamous Cell (complications, drug therapy, surgery)
• Cisplatin (administration & dosage)
• Combined Modality Therapy
• Esophageal Neoplasms (complications, drug therapy, pathology, surgery)
• Esophagectomy
• Humans
• Male
• Middle Aged
• Purpura, Thrombocytopenic (etiology)
• Silicates (administration & dosage)
• Titanium (administration & dosage)