A resected case of esophageal cancer associated with a sarcoid reaction in regional lymph nodes *
A 71-year-old man visited our hospital complainting of swallowing pain in November 2003. A barium esophagram and endoscopic examination revealed annular stenosis of the wall of the middle portion of the esophagus and a diagnosis of type 2 advanced esophageal cancer was made. Preoperative chest computed tomography showed regional lymph nodes swollen and lymph node metastasis was suspected. Subtotal excision of the esophagus was carried out along with two-field lymph node dissection and anastomosis between the stomach tube and cervical esophagus through posterior sternum route in December. Histopathological findings revealed moderately differentiated squamous cell carcinoma, pT3 pN2（2a）ly2 v1 in stage III. Although the number two lymph node was found to be positive for tumor, numerous non-caseating epithelioid cell granulomas were observed in the dissected lymph nodes. Systemic sarcoidosis was not observed and a sarcoid reaction occurs in regional lymph nodes of the esophageal cancer. Lymph node metastasis of esophageal cancer was observed with preoperative diagnosis, but sarcoid reaction was observed with postoperative diagnosis. In conclusion, lymph node metastasis and sarcoid reaction in the number two lymph node made diagnosis difficult. (Accepted on November 26，2007)
