Abstract
BackgroundVerrucous carcinoma is an extremely rare form of cancer in the esophagus.Case presentationA 56-year-old woman presented with dysphagia in 2007. Endoscopic examination revealed an irregular protruding circumferential erosion in the lower thoracic esophagus, but because pathological examination of the biopsy specimen showed no evidence of malignancy, the status of the erosion was followed up by an upper gastrointestinal endoscopic examination every 3 months. A year later, polypoid lesions and fungal infection were observed in the eroded area, but no evidence of malignancy was detected in the biopsy specimen at the time. Eighteen months later, the polypoid lesions had increased in size, and the biopsy specimen was diagnosed as highly suspicious of well-differentiated squamous cell carcinoma. Because the patient’s condition deteriorated due to worsening of the dysphagia and weight loss, we performed a thoracoscopic esophagectomy with lymph node dissection and reconstructed the alimentary tract with a gastric tube via the posterior mediastinal route. Macroscopic examination of the resected specimen showed a white protruding lesion with an irregular surface, and histopathological examination led to a diagnosis of esophageal verrucous carcinoma without lymph node metastasis. No signs of recurrence have been observed in the 8 years since surgery.ConclusionWe have reported a long-term follow-up case of verrucous carcinoma of the esophagus that was difficult to diagnose before surgery.
Highlights
Verrucous carcinoma is an extremely rare form of cancer in the esophagus.Case presentation: A 56-year-old woman presented with dysphagia in 2007
We have reported a long-term follow-up case of verrucous carcinoma of the esophagus that was difficult to diagnose before surgery
It is very difficult to diagnose as Verrucous carcinoma (VC) before surgical excision, because in most cases, the superficial layer of the tumor is covered by nonmalignant tissue [2]
Summary
Verrucous carcinoma (VC) was first described as a variant of squamous cell carcinoma by Ackerman in 1948 [1] and is characterized as a slow growing, well-differentiated, locally spreading tumor. Follow-up examination at 1 year Polypoid lesions and fungal infection were observed on the erosive lesion during the follow-up examination after 1 year (Fig. 3a, b), but no evidence of malignancy was detected during the pathological examination of the biopsy specimens (Fig. 3c, d), and the CT scan showed no particular changes during the period. Follow-up examination at 18 months after the initial examination Polypoid lesions have further increased in size (Fig. 4a, b), and the biopsy specimen was diagnosed as highly suspicious of well-differentiated squamous cell carcinoma. Esophagography revealed irregular stenosis (Fig. 4c), and a CT scan showed circumferential wall thickening in the lower esophagus (Fig. 5a) with increased FDG uptake (SUV max, 9.5) on PET/CT (Fig. 5b). Pathological findings Macroscopic examination of the resected specimen revealed a white protruding lesion with an irregular surface in the lower esophagus (Fig. 6).
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