Intramural squamous cell carcinoma of the esophagus

Abstract

A case of squamous cell carcinoma arising from an esophageal intramural squamous epithelial cyst is reported. Review of the literature reveals no previous reports of malignant transformation of esophageal cysts, although there have been reports of approximately 64 cases of benign esophageal cysts, and 35 cases of carcinoma arising in esophageal diverticula. In the present case, there was a history of increasing dysphagia for 2 months. Esophagram demonstrated a 4.5-cm concentric narrowing of the proximal esophagus just below the superior esophageal ring. Esophagoscopies revealed an esophageal stricture with intact mucosa, and bronchoscopy showed the lesion to be producing tracheal deviation. Multiple esophageal biopsies revealed mild mucosal hyperplasia with deep submucosal inflammatory changes suggesting an underlying lesion. Despite lack of histologic proof of malignancy, the patient underwent radiation therapy and bleomycin chemotherapy on the basis of the highly suggestive radiographic findings, but died with bilateral bronchopneumonia 6 months after admission. Autopsy demonstrated a 1.5-cm long intramural esophageal squamous epithelial cyst, from which arose a locally invasive squamous cell carcinoma, without mucosal involvement or metastases. There was no demonstrable evidence of any associated esophageal diverticulum.

Esophageal squamous cell carcinoma with entirely intramural growth pattern

“…Only one similar case has been reported previously: In the paper by McGregor et al [7], the tumor cells were also located exclusively intramurally and did not invade the overlying epithelium. Quite similar to the observations in our case, the tumor could not be confirmed by endoscopic investigation because of the intact and all in all nonsuspicious appearance of the mucosa.…”

“…The tumor may have originated from squamous epithelium in an esophageal cyst or small diverticulum, like in the case reported by McGregor et al [7]. Alternatively, squamous cell metaplasia in esophageal glands may be the origin of tumor growth.…”

Carcinome épidermoïde de l’œsophage à développement extraluminal

“…Les modèles à développement intramural ou extraluminal sont très rares, trois cas de carcinome à développement intramural ont été rapportés dans la littérature [1][2][3]. Le cas de notre observation illustre un profil de croissance et un mode de découverte inhabituel d'un carcinome épidermoïde de l'oesophage.…”

Esophagus: anatomy and developmental and structural anomalies

“…Marsupialization has been used for the treatment of large cysts, and needle aspiration has been used to relieve tracheal compression from a duplication cyst [85,86]. Although rare, both adenocarcinoma and squamous cell carcinoma within tubular or cystic duplications have been reported [87][88][89].…”