Abstract
A 62-year-old male with a history of type 2 diabetes mellitus and alcoholic liver disease presented with dysphagia, heartburn, and appetite loss. He had lost 10 kg weight within 1 month. The patient gave a history of excessive alcohol intake and a smoking habit of 60 cigarettes per day for 40 years. Upper gastroenteroscopy revealed a wartlike, whitish, protruding mass with circumferential stricture at a point 35 cm from the incisor down to the cardia. Although esophageal cancer was suspected, repeated biopsies of the mass revealed no malignant findings. Concurrent esophageal candidiasis was treated with an antifungal drug. Increased esophageal stricture made food intake impossible; therefore, total parenteral nutrition was initiated. Endoscopic mucosal resection revealed highly keratinized, well-differentiated squamous cell carcinoma with invasion into the submucosa. A diagnosis of verrucous squamous carcinoma was confirmed. Subtotal esophageal resection and esophagostomy was performed with video assistance. Postoperative pathological findings were compatible with the diagnosis of verrucous squamous carcinoma, which is known to be a slow-growing tumor that rarely metastasizes to lymph nodes or distant organs. However, verrucous squamous carcinoma is rarely diagnosed by endoscopic biopsy. Moreover, endoscopic mucosal resection or surgery should be considered in cases when endoscopic examination fails to confirm the diagnosis of carcinoma and if the lesion presents some characteristics of verrucous squamous carcinoma.
Highlights
Verrucous squamous carcinoma (VSC) of the esophagus is an extremely rare variant of squamous cell carcinoma and was first reported by Minielly et al [1] in 1967
VSC of the esophagus is sometimes misdiagnosed as papilloma, leiomyoma, inflammatory tumor associated with reflux esophagitis, or squamous epithelial hyperplasia
Retained esophageal contents resulting from achalasia along with esophageal hernia, esophageal diverticulum, reflux esophagitis, and chronic inflammation may be involved in the pathogenesis of VSC
Summary
Verrucous squamous carcinoma (VSC) of the esophagus is an extremely rare variant of squamous cell carcinoma and was first reported by Minielly et al [1] in 1967 It is a low-grade, slow-growing, locally invasive tumor with a cauliflower-like appearance. Upper gastroenteroscopy performed 9 days after admission revealed a more severe stricture with a whitish mass in the lower esophagus (Figure 2a). Figure 2a: Upper gastroenteroscopy performed 9 days after admission revealed a more severe structure with a whitish mass in the lower esophagus. Microscopic examination revealed mild atypical cells with slightly irregular nuclei, obvious nuclei, and irregular arrangement on the basal membrane; partial invasion to the muscularis propria was observed (Figure 3b) These observations were compatible with the diagnosis of VSC of the esophagus. The patient was asymptomatic with no evidence of recurrence at the 12-month follow-up
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