Abstract
A 55-year-old man was diagnosed as having achalasia 10 years prior. He now presented with dysphasia. Esophagography showed a dilated esophagus, 4.2 cm in maximal diameter, with food residue, indicating a straight-type achalasia. Esophageal endoscopy showed a slight reddish depressed lesion 35 cm from the incisors, and an irregular reddish depressed lesion 37-40 cm from the incisors. Iodine staining revealed multiple irregularly shaped iodine-unstained areas in the esophagus, indicating a ‘madara’ esophagus. Biopsy specimens from the two lesions revealed a high-grade dysplasia of the squamous epithelium. A subtotal esophagectomy was performed. On histopathology, a moderately-differentiated squamous cell carcinoma (SCC) which invaded the submucosal layer was diagnosed (0-IIc, 60 × 58 mm) . In addition, there were five intraepithelial SCC lesions and many dysplastic lesions which were positive for p-53 monoclonal antibody. There have been 30 cases of superficial esophageal carcinoma concomitant with achalasia reported in the Japanese literature. Clinicopathological features of these cases include : a long duration of achalasia symptoms, a prominently dilated esophagus, superficial carcinoma frequently detected after treatment of achalasia, and most frequent distribution in the middle esophagus. In our case, it is likely that prolonged mechanical and chemical irritation due to achalasia led to a p53 mutation and resulted in the development of cancer.
