Year: 2024
Type: article
Study design: Case Report
Abstract: A 53-year-old man presented to Ruijin Hospital, having been followed up for 9 months with an esophageal lesion that had initially been detected during a routine esophagogastroduodenoscopy (EGD) and had been diagnosed histopathologically as a high grade intraepithelial neoplasia (HGIN). The inpatient EGD revealed a flat (0-IIb) and slightly reddish lesion spanning from 25 to 38 cm of the middle-to-lower esophagus ([ Fig. 1 ]). Magnifying endoscopy with blue-laser imaging (ME-BLI) identified an intrapapillary capillary loop (IPCL) pattern consistent with type B1 ([ Fig. 1 ] d–f ). Notably, a 5 × 5-mm slightly elevated area with mild congestion was observed within the lesion at 26 cm ([ Fig. 1 ] a ). The lesion remained unstained after the application of Lugolʼs solution and exhibited a partial pink-color sign from 30 to 33 cm of the esophagus, without any signs of deep invasion ([ Fig. 1 ] g–i ). Pathology and immunohistology of the biopsy specimen revealed CK7+, CK19+, P53(missense mutation), P40(little+), P63(little+), CK5/6(partial+), P16(little+), Ki67(70%+), AE1/AE3+, CAM5.2+, CK20(−), SOX-10(−), villin(−), HER2(0), SATB2(−), GCDFP-15(−) ([ Fig. 2 ]), suggesting (i) extramammary Paget disease; (ii) invasive adenocarcinoma with Paget dissemination (M1 for the biopsy, more tissue would be needed for the evidence of invasive adenocarcinoma) [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Fig. 1 Endoscopic features of the lesion before radiofrequency ablation on: a–c white-light endoscopy; d–f magnifying endoscopy with blue-laser imaging; g–i after staining with Lugol’s solution. Fig. 2 Microscopic appearance of the of biopsy specimen on: a, b hematoxylin and eosin (H&E) staining; c–l immunohistochemical staining with: c CK7(+); d CK19(+); e P53(missense mutation); f P63(little+); g P40(little+); h CK20(−); i Ki67(70%+); j AE1/AE3(+); k CK5/6(partial+); l P16(−). Given the size of the lesion and the patientʼs refusal to undergo surgery, we performed radiofrequency ablation therapy ([ Fig. 3 ]). A follow-up EGD at 2 months post-treatment revealed persistent faintly red, rough mucosa extending from 26 to 38 cm of the esophagus ([ Fig. 4 ]). Notably, brownish areas were observed within the lesion under ME with narrow-band imaging (ME-NBI), with the majority of type B1 IPCL with partial type R vessels ([ Fig. 4 ] b, e ). Subsequent Lugolʼs solution staining delineated an irregularly geographically distributed lesion with partial circumferential involvement ([ Video 1 ]). A biopsy taken at 30 cm demonstrated a pink-color sign ([ Fig. 4 ] f ), confirming the previous diagnosis. Fig. 3 Endoscopic images during radiofrequency ablation therapy. Fig. 4 Endoscopic images during follow-up esophagogastroduodenoscopy 2 months after treatment on: a, d white-light imaging; b, e magnifying endoscopy with narrow-band imaging; c, f after staining with Lugol’s solution. Quality: mobile 360 480 720 Download Features of a rare primary Paget’s disease of the esophagus under white-light endoscopy and magnifying endoscopy with blue-laser imaging/narrow-band imaging before and after radiofrequency ablation treatment.Video 1 The patient currently continues on regular EGD follow-up every 3 months at his local hospital. If the lesion were to worsen during follow-up, chemoradiotherapy would be considered. Endoscopy_UCTN_Code_CCL_1AB_2AC Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 16 August 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-2378-6256
Authors: Xue Chen, Heng Zhang, Aihua Qian, Xi Chen
Institutions: Shanghai Jiao Tong University, Ruijin Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4401629753