A Case of Small Early Carcinoma of the Esophagus with Microinvasion to the Submucosal Layer (sm)

A 45-year-old male complaining of anorexia and heartburn was diagnosed by endoscopic findings that 0-IIc lesion with ulcer and the surrounding scattered erosion due to the reflux esophagitis on the lower esophagus (Ei) . The submucosal invasion was suspected and the total thoracic esophagectomy with reconstruction was performed. The operational findings were Ei-Im-Post, 0-IIc, Pl (-) , N (-) , M (-) , Stage I, R3. The resected specimen revealed superficial carcinoma coexisting with a submucosal tumor in the lower part of the esophagus (Ei) . Microscopic findings showed only 2mm sized 0-IIc lesion was moderately differentiated squamous cell carcinoma with submucosal microinvasion (sm) and n0, ly0, vo, ow (-) , aw (-) , ew (-) . It also revealed the submucosal tumor was leiomyoma (5x3mm) which seemed to arise from the muscularis propria. The patient was discharged with no postoperative complications. Only 2mm in size of the 0-IIc esophageal carcinoma had sm1 microinvasion. It was very rare case, but it provided the question about the indication of the endoscopic mucosal resection (EMR) . The post-operative pathological examination of the resected specimen is important, but also it is more important to preoperatively diagnose the acurate depth of invasion.