Endoscopic submucosal dissection for simultaneous four foci of multiple primary early-stage esophageal cancer after tongue cancer surgery: a case report

<p><strong>Background: </strong>Multiple primary early-stage esophageal cancer is not uncommon in patients with head and neck squamous cell carcinoma, but simultaneous four foci of early-stage esophageal cancer after tongue cancer surgery is rarely reported.</p> <p><strong>Case Presentation:</strong> A 67-year-old male with a history of left tongue base well-differentiated squamous cell carcinoma (pT1N0M0) treated by radical surgery in 2018 presented with dysphagia in October 2024. Gastroscopy revealed four separate iodine-unstained areas in the esophagus. All four lesions were completely resected by endoscopic submucosal dissection (ESD) in a single procedure. Postoperative pathology confirmed that three lesions were pT1a (invasion into the lamina propria mucosa) and one lesion was pT1b (invasion into the submucosa, approximately 0.2 mm), all being moderately differentiated squamous cell carcinoma with negative margins. Due to the pT1b lesion, the patient received adjuvant radiotherapy (50 Gy/25 fractions). At 1.5 years post-surgery, follow-up CT, esophageal barium meal, and serum squamous cell carcinoma antigen showed no evidence of recurrence or metastasis.</p> <p><strong>Conclusion: </strong>This case suggests that patients with head and neck squamous cell carcinoma require long-term regular esophageal screening after surgery. ESD can achieve curative resection for simultaneous multiple foci of early-stage esophageal cancer. Adjuvant radiotherapy is a reasonable choice for pT1b lesions.</p>