Explosive cervical lymph node recurrence following two-field lymphadenectomy in pT1b (SM2) middle esophageal squamous cell carcinoma with INFb pattern and absent lymphovascular invasion: a case report
- 1Department of Thoracic Surgery, Weifang People’s Hospital
- 2Department of Radiation Oncology, Weifang Traditional Chinese Hospital
Abstract
Background: In superficial esophageal squamous cell carcinoma (ESCC), clinical decisions are guided by submucosal invasion depth (200-μm cutoff) and lymphovascular invasion (LVI) status. Although the tumor infiltration (INF) pattern is an independent risk factor, it is often overlooked when planning surgical strategies and surveillance. We report a case highlighting the need to integrate INF classification into practice, with emphasis on cervical lymphatic drainage.
Case Presentation: A 51-year-old man underwent endoscopic submucosal dissection (ESD) for middle thoracic ESCC. Histopathology revealed moderately differentiated SCC with submucosal invasion to 370 μm, staged as pT1b (SM2) (JES classification), with an INFb pattern, negative LVI, and negative margins. Because invasion depth exceeded 200 μm, radical esophagectomy was performed 14 days after ESD. Preoperative CT identified a tiny left 101L (cervical paraesophageal) lymph node, but this was clinically dismissed given the perceived low-risk features. The patient underwent standard two-field lymphadenectomy without adjuvant therapy. CT at 5 months was unremarkable; at 9 months, a 60×39 mm mass appeared in the left 101L region with tumor thrombus in the left internal jugular vein. Biopsy confirmed metastatic SCC. After cervical recurrence, the patient received concurrent chemoradiotherapy; the metastatic node showed partial response after 4 cycles, and further chemotherapy plus sequential immunotherapy is planned.
Conclusion: Middle thoracic ESCC with an INFb pattern may carry a substantial risk of cervical lymph node metastasis, even in pT1b (SM2), LVI-negative tumors. When preoperative imaging reveals cervical nodes of uncertain significance, standard two-field dissection leaves a critical “blind spot.” 18F-FDG PET-CT should be performed in accordance with current staging guidelines, and the extent of lymphadenectomy should be individualized based on preoperative imaging findings. Intensified surveillance using cervical and thoracic thin-slice CT should be considered.
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BibTeX
@article{che2026explosive,
title = {{Explosive cervical lymph node recurrence following two-field lymphadenectomy in pT1b (SM2) middle esophageal squamous cell carcinoma with INFb pattern and absent lymphovascular invasion: a case report}},
author = {Jianpeng Che and Yao Wei and Wei Li and Linlin Ji},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1976165},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1976165/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Explosive cervical lymph node recurrence following two-field lymphadenectomy in pT1b (SM2) middle esophageal squamous cell carcinoma with INFb pattern and absent lymphovascular invasion: a case report
AU - Jianpeng Che
AU - Yao Wei
AU - Wei Li
AU - Linlin Ji
PY - 2026
DA - 2026/10/16
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1976165
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1976165/full
AB - Background: In superficial esophageal squamous cell carcinoma (ESCC), clinical decisions are guided by submucosal invasion depth (200-μm cutoff) and lymphovascular invasion (LVI) status. Although the tumor infiltration (INF) pattern is an independent risk factor, it is often overlooked when planning surgical strategies and surveillance. We report a case highlighting the need to integrate INF classification into practice, with emphasis on cervical lymphatic drainage. Case Presentation: A 51-year-old man underwent endoscopic submucosal dissection (ESD) for middle thoracic ESCC. Histopathology revealed moderately differentiated SCC with submucosal invasion to 370 μm, staged as pT1b (SM2) (JES classification), with an INFb pattern, negative LVI, and negative margins. Because invasion depth exceeded 200 μm, radical esophagectomy was performed 14 days after ESD. Preoperative CT identified a tiny left 101L (cervical paraesophageal) lymph node, but this was clinically dismissed given the perceived low-risk features. The patient underwent standard two-field lymphadenectomy without adjuvant therapy. CT at 5 months was unremarkable; at 9 months, a 60×39 mm mass appeared in the left 101L region with tumor thrombus in the left internal jugular vein. Biopsy confirmed metastatic SCC. After cervical recurrence, the patient received concurrent chemoradiotherapy; the metastatic node showed partial response after 4 cycles, and further chemotherapy plus sequential immunotherapy is planned. Conclusion: Middle thoracic ESCC with an INFb pattern may carry a substantial risk of cervical lymph node metastasis, even in pT1b (SM2), LVI-negative tumors. When preoperative imaging reveals cervical nodes of uncertain significance, standard two-field dissection leaves a critical “blind spot.” 18F-FDG PET-CT should be performed in accordance with current staging guidelines, and the extent of lymphadenectomy should be individualized based on preoperative imaging findings. Intensified surveillance using cervical and thoracic thin-slice CT should be considered.
SN - 2234-943X
ER -