Skip to main content

Advertisement

SpringerLink
Log in

Advanced squamous cell carcinoma in an asymptomatic, large, epiphrenic esophageal diverticulum

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

An asymptomatic epiphrenic diverticulum (ED) was diagnosed in a man undergoing annual esophagogastroduodenoscopy (EGD) at another hospital 40 years before he presented to our hospital at age 63 years for his annual EGD. However, because substantial food retention was found in the ED, we could not confirm a lesion. After the retained food was removed endoscopically, a second EGD showed a reddish, flat lesion with an elevated mass within the ED. Endoscopic ultrasonography indicated that the elevated mass was deep in the submucosal layer. An esophagram showed that the ED was approximately 80 mm in diameter, which is considered large. An endoscopic biopsy of the lesion confirmed squamous cell carcinoma. Total esophagectomy was performed. Microscopic examination revealed well-differentiated to moderately differentiated squamous cell carcinoma invading the adventitia at the elevated lesion. The final pathological stage was pT3N0M0. There was no evidence of recurrence for 3 years during the quarterly follow-up examinations. To our knowledge, this case involved the longest asymptomatic term (40 years) since the ED was detected. A review of 18 reported cases of carcinoma in an ED indicated that advanced cancer has a poor prognosis. Periodic follow-up of ED patients is essential for early diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tedesco P, Fisichella PM, Way LW, et al. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190:891–4.

    Article  Google Scholar 

  2. Fisichella PM, Jalilvand A, Dobrowolsky A. Achalasia and epiphrenic diverticulum. World J Surg. 2015;39:1614–9.

    Article  Google Scholar 

  3. Guerra JM, Zuil M, Garcia I, et al. Epiphrenic diverticula, esophageal carcinoma and esophagopleural fistula. Hepatogastroenterology. 2001;48:718–9.

    CAS  PubMed  Google Scholar 

  4. Hung JJ, Hsieh CC, Lin SC, et al. Squamous cell carcinoma in a large epiphrenic esophageal diverticulum. Dig Dis Sci. 2009;54:1365–8.

    Article  Google Scholar 

  5. Benacci JC, Deschamps C, Trastek VF, et al. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg. 1993;55:1109–13 (discussion 14).

  6. Philippakis M, Karkanias GG, Sakorafas GH. Carcinoma within an epiphrenic esophageal diverticulum. Case report. Eur J Surg Suppl. 1991;157:617–8.

    CAS  Google Scholar 

  7. Song YC, Zhang YD, Wang QZ, et al. Carcinoma in the esophageal diverticulum. Chin Med J. 1985;98:895–8.

    CAS  PubMed  Google Scholar 

  8. Pierce WS, Johnson J. Squamous cell carcinoma arising in a pharyngoesophageal diverticulum. Cancer. 1969;24:1068–70.

    Article  CAS  Google Scholar 

  9. Hoghooghi D, Coakley FV, Breiman RS, et al. Frequency and etiology of midesophageal diverticula at barium esophagography. Clin Imaging. 2006;30:245–7.

    Article  Google Scholar 

  10. Watanabe S, Matsuda K, Arima K, et al. Detection of subclinical disorders of the hypopharynx and larynx by gastrointestinal endoscopy. Endoscopy. 1996;28:295–8.

    Article  CAS  Google Scholar 

  11. Soares R, Herbella FA, Prachand VN, et al. Epiphrenic diverticulum of the esophagus. From pathophysiology to treatment. J Gastrointest Surg. 2010;14:2009–155.

    Article  Google Scholar 

  12. Gawande AS, Batiuchok W, Barman AA, et al. Carcinoma within lower esophageal (epiphrenic) diverticulum. NY State J Med. 1972;72:1749–51.

    CAS  Google Scholar 

  13. Fujita H, Kakegawa T, Shima S, et al. Carcinoma within a middle esophageal (parabronchial) diverticulum: a case report and the review of the literature. Jpn J Surg. 1980;10:142–8.

    Article  CAS  Google Scholar 

  14. Honda H, Kume K, Tashiro M, et al. Early stage esophageal carcinoma in an epiphrenic diverticulum. Gastrointest Endosc. 2003;57:980–2.

    Article  Google Scholar 

  15. Eluvathingal Muttikkal TJ, Shami VM, et al. FDG positron emission tomography and computed tomography demonstration of carcinoma arising in an epiphrenic diverticulum. J Radiol Case Rep. 2014;8:42–6.

    PubMed  PubMed Central  Google Scholar 

  16. Yoshinaga S, Oda I, Nonaka S, et al. Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers. World J Gastrointest Endosc. 2012;4:218–26.

    Article  Google Scholar 

  17. Zinner E. Carcinoma within an epiphrenic diverticulum. Bull Gastrointest Endosc. 1963;10:14–6.

    CAS  PubMed  Google Scholar 

  18. Plous E, Freedman J, Wolf PL. Carcinoma within a lower esophageal (epiphrenic) diverticulum. J Thorac Cardiovasc Surg. 1964;47:129–32.

    Article  CAS  Google Scholar 

  19. Thomas RC. Carcinoma in epiphrenic diverticula. Ann Thorac Surg. 1968;6:85–7.

    Article  CAS  Google Scholar 

  20. Shin MS. Primary carcinoma arising in the epiphrenic esophageal diverticulum. South Med J. 1971;64:1022–4.

    Article  CAS  Google Scholar 

  21. Saldana JA, Cone RO, Hopens TA, et al. Carcinoma arising in an epiphrenic esophageal diverticulum. Gastrointest Radiol. 1982;7:15–8.

    Article  CAS  Google Scholar 

  22. Schultz SC, Byrne DM, De Cunzo P, et al. Carcinoma arising within epiphrenic diverticula. A report of two cases and review of the literature. J Thorac Cardiovasc Surg. 1996;37:649–51.

    CAS  Google Scholar 

  23. Lai ST, Hsu CP. Carcinoma arising from an epiphrenic diverticulum: a frequently misdiagnosed disease. Ann Thorac Cardiovasc Surg. 2007;13:110–3.

    PubMed  Google Scholar 

  24. Conklin JH, Singh D, Katlic MR. Epiphrenic esophageal diverticula: spectrum of symptoms and consequences. J Am Osteopath Assoc. 2009;109:543–5.

    PubMed  Google Scholar 

  25. Choi AR, Chon NR, Youn YH, et al. Esophageal cancer in esophageal diverticula associated with achalasia. Clin Endosc. 2015;48:70–3.

    Article  Google Scholar 

  26. Fu K, Jin P, He Y, et al. A superficial esophageal cancer in an epiphrenic diverticulum treated by endoscopic submucosal dissection. BMC Gastroenterol. 2017;17:94.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata , Niigata, 951-8510, Japan

    Tomoaki Yoshida, Satoru Hashimoto, Ken-ichi Mizuno & Shuji Terai

  2. Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Hiroshi Ichikawa

  3. Department of Endoscopy, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Junji Yokoyama

  4. Division of Pathology, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Hajime Umezu

Authors
  1. Tomoaki Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satoru Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken-ichi Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Junji Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hajime Umezu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shuji Terai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoru Hashimoto.

Ethics declarations

Conflict of interest

Tomoaki Yoshida, Satoru Hashimoto, Ken-ichi Mizuno, Hiroshi Ichikawa, Junji Yokoyama, Hajime Umezu and Shuji Terai declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, T., Hashimoto, S., Mizuno, Ki. et al. Advanced squamous cell carcinoma in an asymptomatic, large, epiphrenic esophageal diverticulum. Clin J Gastroenterol 13, 477–482 (2020). https://doi.org/10.1007/s12328-020-01098-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-020-01098-4

Keywords

Search

Navigation