Abstract
The patient was a 78 year-old male, who was being followed after radiation therapy for cervical esophageal cancer diagnosed when he was 75 years old. During follow-up endoscopy confirmed a 7 mm reddish elevated lesion in the anterior wall of the lower thoracic esophagus was found. On magnifing esophagoscopy with NBI, a localized brown colored region traversed by a web of large diameter blood vessels of varying sizes was observed. No avascular areas were detected. On pathology of the biopsied specimen an undifferentiated carcinoma was diagnosed, but no definitive diagnosis. Therefore a total excision was done endoscopically. On pathology, atypical cells which had scant cell cytoplasm and rich chromatin were noted growing in a rosette pattern in the lamina propria mucosa located directly below the thinned epithelium, a pseudo-cavity was noted in one area. The lesion was positive for Chromogranin A, synaptophysin, and CD56, and was diagnosed as an endocrine cell carcinoma. Vein growth in the tumor was observed through CD34 staining. Though a high grade squamous intraepithelial neoplasia was found, no connection was established with the endocrine cell carcinoma noted in the lamina propria mucosa. Microscopic examination of blood vessels under magnification is useful for determing the depth of cancer invasion, as well as its specific histological type.
