Signet ring cell carcinoma of the esophagus treated by video-assisted surgery: report of a case

We report a case of Barrett’s adenocarcinoma consisting of a signet ring cell carcinoma (SIG) and well-differentiated adenocarcinoma treated by video-assisted surgery. The patient was a 73-year-old man with esophagitis endoscopically detected 5 years earlier. Esophagogastroscopy showed an ulcerative tumor (lesion 1) with a small protruding tumor (lesion 2) in the lower esophagus. Biopsy specimens taken from lesions 1 and 2 showed SIG and a well-differentiated adenocarcinoma, respectively. The patient underwent video-assisted surgery for the esophageal carcinoma. Macroscopically, the resected tumor consisted of a type 2 tumor (lesion 1, 25 mm in diameter) and a type 0-IIa tumor (lesion 2, 10 mm in diameter) of the lower esophagus. Histologically, lesion 1 showed SIG invading the submucosal layer of the esophagus, and lesion 2 showed a well-differentiated adenocarcinoma limited to the mucosa. The two lesions were continuously observed, and a moderately differentiated adenocarcinoma was observed between lesions 1 and 2. Near the tumor, the double muscle layer of the mucosa and the esophageal glands were observed under the columnar epithelium. In immunohistochemistry, both lesions showed positive reactions for MUC5AC and MUC2 but showed no reaction for MUC6. The tumor was diagnosed as SIG concomitant with a well-to moderately differentiated adenocarcinoma arising from Barrett’s esophagus (pT1b pN0 M0). The patient is alive without recurrence 60 months after surgery.