Verrucous carcinoma of the esophagus: A case report and literature review

Abstract

Verrucous carcinoma of the esophagus is a variant of a squamous cell cancer. Our case is a 78-year-old male patient comes in with the dysphagia and weight loss, and on endoscopy (EGD) he is found to have an irregular intraluminal mass at the distal esophagus. With the deep EGD assisted biopsy, diagnosis of the verrucous carcinoma is made. Due to multiple co morbidities and possible infiltration to the pericardium, patient is taken for the esophageal stent placement and is being referred for the chemo-radiation treatment. The diagnosis can be very difficult to make with the superficial biopsies due to very non specific histological changes and requires very high clinical suspicion and deep mucosal biopsies are required for accurate diagnosis of the tumor. Chronic and local disease process is the main risk factor for the development of the verrucous carcinoma of the esophagus. Surgery is the treatment of the choice for the early stage tumor and advanced cases are treated with the palliation and possibly chemo- radiation. The prognosis is usually guarded and needs long term follow up.

Rare tumors of esophageal squamous mucosa

“…The age distribution of VC ranges from 35 to 80 years (median 61) with a male predilection (M:F = 2:1). Site distribution within the esophagus varies among lower (70%), upper (23%), and middle (7%) in various studies . As also apparent in conventional esophageal SCC, correlation of human papilloma virus (HPV) with VC has also been demonstrated in some studies, mainly HPV‐types 51 and 11 .…”

“…It was first reported in the esophagus in 1967 by Minielly et al . Since then, only a handful of esophageal cases (<30) have been reported . The age distribution of VC ranges from 35 to 80 years (median 61) with a male predilection (M:F = 2:1).…”

Advanced Verrucous Squamous Cell Carcinoma of the Esophagus: Case Report and Literature Review

“…The typical endoscopic appearance of esophageal VSCC shows shaggy, white, exophytic, wart-like, velvety, papillary, spiked and cauliflower-like mass, and the tumor occurs mainly from the middle to lower esophagus. 7,8 Westerterp et al 9 reported that the white masses that are a result of keratinization develop focal dysplasia and SCC. In addition, endoscopic ultrasonography, narrow-band imaging (NBI) and iodine-staining can each play an adjuvant role in the preoperative diagnosis.…”

“…In addition, endoscopic ultrasonography, narrow-band imaging (NBI) and iodine-staining can each play an adjuvant role in the preoperative diagnosis. 8,10 In chromoendoscopy, a dramatic color change after iodine staining, from the yellow to pink 2-3 min later, is known as the pink-color sign (PCS), which is useful for identifying cancerous lesions. 11 The PCS has been reported to improve specificity for esophageal high-grade intraepithelial neoplasia and invasive cancer.…”

“…8 With improvements in minimally invasive surgery, video-assisted thoracoscopic surgery with the patient in the prone position is a safe and effective technique for treatment of advanced esophageal VSCC.…”