SYNCHRONOUS CANCERS OF THE ESOPHAGUS AND THE AMPULLA OF VATER AFTER DISTAL GASTRECTOMY - SUCCESSFUL REMOVAL OF THE ESOPHAGUS, GASTRIC REMNANT, DUODENUM, AND PANCREATIC HEAD

A case of synchronous squamous cell carcinoma of the esophagus and ade nocarcinoma of the ampulla of Vater after previous gastrectomy is pres ented, The coexistence of these two lesions has never been reported in the English literature. We performed a subtotal esophagectomy, total residual gastrectomy, and pancreaticoduodenectomy with lymph node diss ection in a one-stage procedure. An operation of this magnitude could be safely performed with attention to meticulous surgical technique an d intensive postoperative care. Histologic examination of the ampulla lesion showed adenocarcinoma with Paneth-cell differentiation. This is a rare lesion, and a review of the literature revealed only one other case. Neoplastic Paneth cells were also found in a lymph node metasta sis that originated from the ampulla tumor. This case confirms that ce lls with Paneth-cell differentiation can be a significant component in invasive carcinoma. (C) 1995 Wiley-Liss, Inc.