Case 1- A 54-year-old male patient with a history of tuberculosis 29 years ago presented with dysphagia. In his endoscopic examination, an ulcerated lesion was detected in the esophagus between 30 cm and 35 cm from the incisors. The histopathological examination result was reported as a well-differentiated squamous cell carcinoma (Figure 1a-f). Computed tomography (CT) of the thorax detected a diffuse lesion of malignant appearance extending to the paraesophageal and subcarinal fatty tissue in the middle part of the esophagus approximately 5 cm in the segment, reaching up to 15 mm in thickness; alveolar densities and calcific nodules with chronic sequelae bilaterally in the lung parenchyma due to previous tuberculosis; and a 20x25 mm malignant nodular lesion with irregular borders in the anterior of the lower lobe of the right lung (Figure 1a, b). In addition, fluorodeoxyglucose positron emission tomography (FDG-PET) imaging showed a hypermetabolic focus in the right supraclavicular area (maximum standardized uptake value [SUVmax]: 3.98); a hypermetabolic mass lesion in the esophagus starting from the carina level and continuing as a concentric wall thickening in a 55 mm segment on the coronal axis (SUVmax: 11.20); diffuse, calcific, FDG-negative tuberculous sequela lesions bilaterally in the lung parenchyma and mediastinum; a hypermetabolic parenchymal nodular lesion with lobulated contours in the anterobasal segment of the lower lobe of the right lung showing heterogeneous metabolic activity (late SUVmax: 9.99) (Figure 1c, d). 
There was no metastasis evident in the cranial magnetic resonance imaging (MRI). It was decided to perform supraclavicular lymphadenopathy (LAP) biopsy and transthoracic aspiration biopsy (TTAB) from the lung mass, as agreed in the Multidisciplinary Tumor Council (MTC). The supraclavicular lymph node biopsy was negative for malignancy, but an adenosquamous cell carcinoma was revealed in the TTAB of the mass in right lower lobe. The histopathological examination was reported as revealed an adenosquamous cell carcinoma (Figure 1e). Based on these results, the esophageal tumor T3N?M0 was staged as a lung tumor T3N0M0 and neoadjuvant chemoradiotherapy (CRT) were initiated for the esophageal tumor. A total of 50.4 Gy was administered at 1.8 Gy/Fx during 28 Fx sessions with external intensity-modulated radiation therapy (IMRT) and concurrent and weekly, paclitaxel and carboplatin/AUC2 were administered at 50 mg/m2. 
Post-treatment control FDG-PET showed that metabolic activity completely disappeared in the esophageal lesion followed at the carina level (complete metabolic response to treatment). However, an increase in the size and metabolic activity of the mass in the right lower lobe"s superior segment was detected. The patient"s case was discussed again by the MTC regarding the re-staging results after neoadjuvant CRT. Based on the diagnosis of synchronous lung and esophageal tumors, a collective decision was made for curative resection for both tumors. In exploration, a lesion of approximately 5x4 cm mass was detected in the anterobasal segment of the lower lobe of the right lung. Frozen sections were studied after sampling the lymph nodes station of 2, 4, 9, and 7. The result was reported as tumor-negative. 
Based on these results, it was decided to perform a right lower lobectomy initially. Right lower lobectomy and mediastinal LND were, then, performed. Following these procedures, the esophagus was suspended and the surrounding tissues were freed. In the second stage, the abdomen was entered with a median incision over the umbilicus in the supine position. The stomach was skeletonized and tubed and a conduit was prepared. The esophagus was explored on the left side of the neck and the conduit was pulled into the neck. The posterior wall of the stomach and esophagus anastomosis was performed with a 45-mm Endo GIA  (Medtronic Inc., MN, USA), while the anterior wall was anastomosed manually. After the methylene blue test on the sixth postoperative day, oral nutrition was started. Due to chylous drainage from the chest tube, a special diet for chylothorax was initiated. On Day 5 of follow-up, re-exploration was decided, as the amount of drainage from chest drain reached 1000 mL/day. Thoracic duct was reattached through the diaphragmatic hiatus. The patient was discharged on Day 16 of follow-up. The patient, who did not have any additional problems at the first month of follow-up, was consulted to the oncology outpatient clinic.
PET-CT showing a diffuse malignant lesion in the middle part of the esophagus, and ,20 mm x25 mm malignant nodular lesion in lower lobe of the right lung, adenosquamous carcinoma,.