Esophageal Verrucous Carcinoma That Developed 30 Years after Esophageal Trauma

Abstract

A 71-year-old man who suffered esophageal damage due to an accident approximately 30 years previously complained of dysphagia. Endoscopic examination revealed a whitish papillary tumor in the esophagus. Biopsy results seemed to suggest an extremely well-differentiated squamous cell carcinoma or inflammation, but a definitive diagnosis could not be reached despite multiple inspections. Chest CT showed irregular thickening of the wall of the esophagus and pneumonia by penetration, and PET showed high trace accumulation in the affected area. We decided to operate on the patient due to the possibility of cancer, potential obstruction to the passage of food, and secondary pneumonia. Intraoperatively, the tumor was found to be soft and edematous, and since intraoperative diagnosis of pleural lavage fluid and the LN around the recurrent laryngeal nerve were negative, we performed thoracic esophagectomy without typical lymph node dissection, and reconstruction using a gastric tube. Gross examination of the tumor revealed a warty appearance. HE staining showed that the squamous laminar structure of the esophagus was maintained, although a slight variant form was present. Immunostaining revealed the tumor to be verrucous carcinoma (VC) with a positive reaction of basal layer to p53, p63 and Ki67 as biomarkers. VC is a subtype of squamous cell carcinoma that most commonly occurs in the mouth. We report a rare case of esophageal VC with a review of the literature of similar cases.