PMC9981638_01
Chest CT scan on December 26, 2020, showing postoperative stent changes in the aortic arch and descending aorta and local thickening of the middle esophagus. (Because the patient showed allergy to contrast agents in the past, enhanced CT was not performed.).
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A 63-year-old male patient was admitted to the hospital on December 23, 2020, due to "progressive dysphagia" and underwent gastroscopic biopsy and chest computed tomography (CT) ( Figure 1 ).
Postoperative pathology of the resected esophageal tumor: (A) HE: 10x10. The tumor cells were arranged in a solid nest and grew in an infiltrative manner. Intraventricular tumor emboli (indicated by arrow) were observed. (B) HE: 40x10. The tumor cells were polygonal in shape with an eosinophilic cytoplasm, and vacuoles were observed in some of the cytoplasm, with round, oval or irregular nuclei and rough nuclear chromatin; pathological mitosis was observed. (C) Magnification: 10x10. Immunohistochemical marker CK5/6 (+). (D) Magnification: 10x10. Immunohistochemical marker P40 (+). (E) Magnification: 10x10. Immunohistochemical marker KI67 (high proliferation index, +40%).
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P16 (-), P40 (+), and CK5/6 (+) ( Figure 2 ). Postoperative radiotherapy and chemotherapy were not performed.
On September 30, 2021, pelvic MRI showed irregular thickening of the intestinal wall at the lower rectum (approximately 1.4 cm from the anal orifice), with the posterior wall predominating, accounting for approximately 2/3 of the circumferential wall, with a thicker area of approximately 1.8 cm. The enhanced scan showed obvious heterogeneous enhancement. The length of the lesion was approximately 3.8 cm, and multiple small lymph nodes were enhanced in the mesorectum.
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On September 30, 2021, pelvic magnetic resonance imaging (MRI) showed irregular thickening of the intestinal wall in the lower rectum and small lymph nodes in the mesorectum; neoplastic lesions were considered ( Figure 3 ).
Postoperative pathology of the rectum: (A) The tumor cells had infiltrated the subepithelial interstitium in a nested, mass-like manner, and intravascular tumor emboli (indicated by the arrow) were visible, showing a clear boundary with the squamous epithelium near the rectum. (B) The tumor tissue showed mass and nested infiltrative growth, the epithelial-like cells outside the nest showed a basal cell-like arrangement, and residual mucinous glands were seen in the background of hemorrhage. (C, D) Magnification: 10x10. Immunohistochemical marker CK5/6 (+). (E, F) Immunohistochemical marker P63 (+). (G, H) Immunohistochemical marker KI67 (high proliferation index, +80%).
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CK (+), CK5/6 (+), P63 (+), Ki-67 (+, approximately 80%), CD34 (vascular +), CDX2 (-), CEA (-), CgA (-), D2-40 (lymphatic vessel +), P16 (-), P53 (-), and Syn (-) ( Figure 4 ). Cell morphology and immunolabeling results confirmed that the esophagus was the origin.