2018 Volume 60 Issue 5 Pages 1076-1082
We performed endoscopic submucosal dissection (ESD) for multiple superficial esophageal cancers in a case coexisting with esophageal achalasia. The patient was a 55-year-old man who suffered from dysphagia for the past 18 years. He was diagnosed as having esophageal achalasia by various imaging examinations that revealed the morphology and function of the esophagus. Then, screening esophagogastroduodenoscopy detected multiple superficial esophageal cancers at the upper part (1 lesion) and the middle part (5 lesions) of the esophagus. All esophageal lesions at the upper and middle parts of the esophagus in the patient who had already been diagnosed with esophageal achalasia, were successfully removed by ESD. Pathological examination showed squamous cell carcinoma for three lesions and high-grade intraepithelial neoplasia for the other three lesions. Immunostaining for p53 showed positivity in not only cancer cells but also non-cancerous cells. In this case, it is likely that prolonged mechanical and chemical irritations due to achalasia led to a p53 mutation and resulted in the development of cancer. It is important to carry out careful long-term follow-up for patients with achalasia to detect esophageal cancer as soon as possible. We herein report such a patient with a review of the relevant literature.
