PMC3420659_01
Endoscopic examination and gross presentation. (a) Presence of a white mass in the mucosa. (b) The resected esophagus showed mucosal abnormalities located 1 cm from the proximal margin. The entire esophagus was very hardened and thick.
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The man went to the local hospital and had a gastroscopic examination, which showed a mass of about 1.3 cm x 1.2 cm in size (Figure 1(a)), located on the posterior wall 34 cm from the incisors. There was mucosal erosion of about 1.2 cm x 1.1 cm in size (Figure 1(b)), located 1 cm from the proximal margin.
Histologic examination. (a) Presence of three lesions between the normal tissue. (b) Superficial squamous cell carcinoma with infiltration of eosinophils into the tumor cells and lamina propria. (c) Presence of mucosal coloboma. (d) The eosinophils infiltrated the muscle fiber and nerve plexus. (e) Presence of basal hyperplasia. (f) Changes in polarity and size of the cell and nuclei. (g) Basal parabasal cells expressed p53. (h) Eosinophils invaded the lymph nodes.
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Five tissues were biopsied (Figure 2(a)). In some areas, the cells penetrated through the epithelial basement and invaded the lamina propria (Figure 2(b)). After esophageal resection, there were mucosal coloboma and no remnants of squamous cell carcinoma (Figure 2(c)). The striking feature is that eosinophils diffusedly invaded the mucosa, submucosa, muscularis, and adventitia (Figure 2(c)). The notable characteristic was the eosinophilic abscess in the muscularis (Figure 2(d)). The nerve plexus in the muscularis was also separated by eosinophils (Figure 2(d)). Although there was no remnant squamous cell carcinoma, basal cell hyperplasia is common (Figure 2(e)) and thus altered architecture and abnormalities in cytology could be seen (Figure 2(f)). In some areas, about 2% the basal cell and parabasal cells expressed p53 (Figure 2(g)). Many eosinophils filled the sinus of the esophagus lymph node (Figure 2(h)).
Blood smear (Wright Giemsa). (a) The examination before surgery showed 52% eosinophils. (b) The examination after surgery showed 10% eosinophils.
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A subsequent blood smear examination showed 50% (absolute number was 3.70 x 109) eosinophils (Figure 3(a)). Although the esophagus was resected, the eosinophil count decreased to 10% (absolute number was 0.69 x 109) (Figure 3(b)).