Nobuhiro Takeuchi, Shuho Semba, Kazuyoshi Naba, Tetsuo Maeda, Hidetoshi Tada, Ryota Aoki, Yu Nishida and Yusuke Nomura
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.
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