Lymph node metastatic recurrence detected by an increased serum carcinoembryonic antigen concentration after endoscopic submucosal dissection for esophageal cancer with invasion to the lamina propria mucosae.

A 64-year-old man underwent endoscopic submucosal dissection (ESD) for squamous cell carcinoma in the upper thoracic esophagus. The resected specimen was histopathologically diagnosed as esophageal squamous cell carcinoma with pathological invasion to the T1a-lamina propria mucosae without lymphovascular invasion and was determined to have been curatively resected. Twenty-six months after ESD, the patient had an increased serum carcinoembryonic antigen (CEA) concentration of 14.0 ng/mL. Comprehensive examination revealed multiple lymphadenopathies. A biopsy of the right supraclavicular lymph node confirmed metastasis of squamous cell carcinoma. Immunohistochemical study for CEA was focally positive in the primary ESD specimen, whereas nearly all tumor cells in the metastatic lesion were positive. Therefore, it was considered that the metastatic lesion originated from the CEA-positive subpopulation of the primary tumor. This is the first case of lymph node metastatic recurrence detected based on an increased serum CEA concentration after ESD for esophageal squamous cell carcinoma with invasion to the T1a-lamina propria mucosae. Serum CEA measurement was useful for detecting the recurrence. Furthermore, this case suggests that CEA immunohistochemical study may be useful for the assessment of metastatic risk following curative ESD for esophageal squamous cell carcinoma.