PMC5603115_01
Upper gastrointestinal endoscopy showed a "0-IIb+IIa" lesion in the middle esophagus (a). Iodine staining revealed multiple irregularly shaped iodine-unstained areas (b).
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During an annual checkup, endoscopy revealed a "0-IIb+IIa" lesion in the middle esophagus (Figure 1(a)). Iodine staining revealed multiple irregularly shaped iodine-unstained areas spreading to the cervical esophagus (Figure 1(b)).
Barium esophagram showed esophageal dilation with a gradual tapering down to the gastroesophageal junction. There was a superficial protruding lesion in the midthoracic esophagus (arrowhead).
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Barium esophagram (Figure 2) showed esophageal dilation with a gradual tapering down to the gastroesophageal junction.
Intraoperative findings showed dilated esophagus. We secured the surgical field by elevating the esophagus dorsally and pushing down the trachea ventrally.
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Dilation of the esophagus resulted in difficulty with securing the surgical field, but we were able to manage by changing the grasping parts frequently (Figure 3). Histopathology showed a moderately differentiated SCC invading the submucosal layer (Figures 4(a)(1) and 4(b)), as well as two SCC invading the mucosal layer (Figure 4(a)(2), (3)).
Resected specimen (a). There are three lesions ((1)-(3)) in the markedly dilated esophagus. Moderately differentiated SCC cells invaded the submucosal layer at elevated lesion (b). Loss of ganglion cells in the myenteric plexus throughout the length of the resected esophagus (c).
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Histopathology showed a moderately differentiated SCC invading the submucosal layer (Figures 4(a)(1) and 4(b)), as well as two SCC invading the mucosal layer (Figure 4(a)(2), (3)). Other histopathologic findings included marked dilation of the upper-middle esophagus and loss of ganglion cells in the myenteric plexus throughout the length of the resected esophagus (Figure 4(c)) (Grade III at both the dilated part and the nondilated part, according to descriptive rules for achalasia of the esophagus).