Endoskopie heute 2014; 27 - P3
DOI: 10.1055/s-0034-1371038

Verrucous Squamous Carcinoma of the Esophagus: rare and difficult to diagnose

AR Elkharsawi 1, M Abbas 2, A Negm 1, M Winkler 3, MP Manns 4, TO Lankisch 1
  • 1Medizinischen Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Endoskopie, Hannover, Deutschland
  • 2Medizinischen Hochschule Hannover, Institut für Pathologie, Hannover, Deutschland
  • 3Medizinischen Hochschule Hannover, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Deutschland
  • 4Medizinischen Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Deutschland

Fragestellung:

A 54 year old male, heavy smoker, with a long history of alcohol abuse, presented presented with 4 month history of progressive dysphagia, but the physical examination was unremarkable. An upper endoscopy showed white papillary, spiked, wart-like appearing lesions involving the mid and lower esophagus from 28 cm to 41 cm from incisor teeth (Image 1) with no involvement of the gastroesophageal junction. The esophageal lumen was narrow, but without obstruction. Multiple biopsies were taken from this lesion, but the pathology report showed inflammation but no evidence of malignancy. Endoscopic examination and biopsies were repeated and had the same findings as the first.

Image 1

Ziel:

An endoscopic ultrasound (EUS) performed using a radial echoendoscope showed thick circumferential hypoechoeic lesion with submucosal invasion and several enlarged paraesophageal lymph nodes. This lesion was suspicious for a T1, N1 esophageal carcinoma. A thoracic and abdominal computed tomography (CT) was also performed which detected one hilar lymph node and excluded distant metastasis.

Methodik:

Although histology obtained by endoscopy remained negative, the patient underwent esophagectomy with gastric pull-up as the history, radiographic, endoscopic and EUS findings were highly suspicious for esophageal carcinoma, the resected specimen (Image 2) revealed verrucous squamous cell carcinoma (VSC) (Image 3).

Image 2

Image 3

Post operatively, the patient recovered without complications.

Ergebnis:

We presented a rare case of VSC of the esophagus which is a rare variant of squamous cell carcinoma, first described in 1948. Only 25 cases are reported in the literature so far. Studies show association between incidence of VSC with tobacco use and alcohol. Surgical resection must be considered in case of presence of EUS and CT findings suspicious for malignancy, even if repeat biopsies failed to obtain an evidence for malignancy.