Adenocarcinoma arising in colonic interposition with endobronchial metastasis

A 41-year-old woman presented with progressive dysphagia for solid foods, intermittent low-grade fever and exertional dyspnea over the preceding 2 months. Fifteen years earlier, she had experienced alkaline corrosive injury to the esophagus and stomach, and underwent a total esophagectomy and subtotal gastrectomy plus reconstruction with colonic interposition. She tolerated the surgery well and maintained a stable body weight after the operation. On admission, a physical examination disclosed pale conjunctivae and diminished breath sound of the right side chest. Laboratory tests showed a hemoglobin of 5.1 g/dl, a white blood cell count of 21.1 × 109/l and C-reactive protein of 11.41 mg/l. The patient’s serum carcinoembryonic antigen was within normal limits. A chest X-ray and computed tomography (CT) …