Abstract
An 81-year-old man underwent surgery for esophageal achalasia at 57 years of age. He received periodical endoscopic examination annually. When 75 years old, an irregular slightly depressed lesion was detected on the left esophageal wall at 31-34 cm from the incisors, and pathological examination of a biopsy specimen revealed high grade intraepitherial neoplasia. We performed argon plasma coagulation (APC) on the lesion. When the patient was 76 years old, a superficial protruding lesion with a slightly elevated component was detected at the right esophageal wall at 21-28 cm from the incisors. Pathological examination of a biopsy specimen from this lesion revealed squamous cell carcinoma. As we diagnosed the depth of tumor invasion to be the submucosal layer, we performed chemoradiotherapy. Complete remission was achieved. Endoscopic examination when the patient was 81 years old revealed a flat reddish lesion on the left wall at 30 cm from the incisors; pathological examination of the biopsy specimen was high grade intraepitherial neoplasia. After 6 months, the lesion became a slightly depressed lesion and narrow band imaging (NBI) endoscopy showed irregular intraepithelial papillary capillary loops within a brownish area. Depth of tumor invasion was diagnosed as mucosal layer, and we performed endoscopic submucosal dissection (ESD). Although fibrous change of the submucosal layer was marked, we successfully resected the lesion without perforation or bleeding. Pathological examination of the ESD specimen was squamous cell carcinoma (SCC), INFa, pT1a-EP, ly0, v0, pHM0, pVM0 according to the Japanese Classification of Esophageal Cancer, 10th edition. The patient is well without recurrence after one year.
