Esophageal early basaloid squamous carcinoma with unusual narrowband imaging magnified endoscopy findings.

Abstract

Basaloid squamous carcinoma (BSC) is a rare variant of esophageal cancer. There are very few reports of "early" BSC. Here we report a case of early BSC with unusual findings by narrowband imaging magnified endoscopy (NBI-ME). A 70-year-old man with a middle thoracic esophageal tumor was referred to our hospital. White-light endoscopy revealed a reddish depressed lesion 5 mm in diameter having a subepithelial tumor-like prominence with a gentle rising slope. NBI-ME revealed irregular loop-shaped microvessels coexistent with thick irregularly branched non-looped vessels. Iodine staining revealed a pale brown lesion. We performed endoscopic submucosal dissection for diagnostic treatment. Histologic examination showed the proliferation of basal cell-like hyperchromatic tumor cells in the lamina propria and with slight invasion into the submucosa at a depth of 320 μm. The tumor cells formed solid nests and microcystic structures, containing an Alcian blue-positive mucoid matrix. The surface was covered with squamous epithelium without cellular atypia. Thin vessels were observed in the intra-epithelial papilla and thick vessels were observed around the solid nests beneath the epithelium. Based on these findings together, we diagnosed the lesion as BSC. In this case, the NBI-ME findings differed from those of typical squamous cell carcinoma in that both non-invasive cancer-like irregular loop-shaped microvessels coexisted with massively invasive cancer-like thick non-looped vessels. We speculate that the looped and non-looped vessels observed by NBI-ME histologically corresponded to thin vessels in the intra-epithelial papilla and thick vessels around the tumor nests, respectively. These NBI-ME findings might be a feature of early esophageal BSC.

• Authors: Yugo Kai, Motohiko Kato, Yoshito Hayashi, Tomofumi Akasaka, Shinichiro Shinzaki, Tsutomu Nishida, Masahiko Tsujii, Eiichi Morii, Tetsuo Takehara
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 20 Issue 35 Pg. 12673-7 (Sep 21 2014) ISSN: 2219-2840 [Electronic] United States
• PMID: 25253974 (Publication Type: Case Reports, Journal Article)

Chemical References

• Biomarkers, Tumor

Topics

• Aged
• Biomarkers, Tumor (analysis)
• Biopsy
• Carcinoma, Squamous Cell (blood supply, chemistry, pathology, surgery)
• Dissection (methods)
• Early Detection of Cancer
• Esophageal Neoplasms (blood supply, chemistry, pathology, surgery)
• Esophageal Squamous Cell Carcinoma
• Esophagoscopy (methods)
• Humans
• Image Enhancement
• Immunohistochemistry
• Male
• Microvessels (chemistry, pathology)
• Narrow Band Imaging
• Predictive Value of Tests
• Treatment Outcome