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From question on page 10.1136/gut.2006.119032

Histological analysis of the specimens obtained by endoscopic biopsy revealed squamous cell carcinoma.

To investigate the primary site of the squamous cell carcinoma, a second oesophagogastroduodenoscopy was performed. It revealed an oesophageal carcinoma measuring 50 mm in diameter in the middle oesophagus (fig 1). Biopsy specimens of the oesophageal lesion also revealed squamous cell carcinoma. Endoscopic ultrasonography showed invasion of the oesophageal carcinoma into the deep portion of the submucosa. The oesophageal and gastric lesions were distant from each other and were not continuous. Direct invasion of the metastatic lesions around the stomach to the stomach was ruled out by CT. The gastric lesion was therefore diagnosed as metastasis of the oesophageal carcinoma. Both oesophageal and gastric lesions (fig 2) responded partially to chemoradiotherapy. Although rare, the possibility of metastatic tumours to the stomach from oesophageal carcinoma sites should be considered.1

Figure 1 (A) Endoscopic view of the oesophageal squamous cell carcinoma in the middle oesophagus. (B) Endoscopic view of the middle oesophagus stained with Lugol’s iodine solution (same area as shown in A). The unstained area reveals the oesophageal squamous cell carcinoma. Patient consent for publication of this figure has been obtained.
Figure 2 Retroflexed endoscopic view of the lesser curvature of the stomach after chemoradiotherapy (the same area as shown in Fig. 1 of the question), showing the partial response to the treatment. Patient consent for publication of this figure has been obtained.

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