Case Report
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World J Gastroenterol. Apr 21, 2014; 20(15): 4453-4456
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4453
Squamous cell carcinoma after radiofrequency ablation for Barrett's dysplasia
Sebastian S Zeki, Rehan Haidry, Manuel Justo-Rodriguez, Laurence B Lovat, Nicholas A Wright, Stuart A McDonald
Sebastian S Zeki, Nicholas A Wright, Stuart A McDonald, Centre for Tumour Biology, Bart’s Cancer Institute, London EC1M 6BQ, United Kingdom
Rehan Haidry, Laurence B Lovat, Research Department of General Surgery, University College London, London WC1E 6BT, United Kingdom
Manuel Justo-Rodriguez, Department of Pathology, University College London, London WC1E 6BT, United Kingdom
Author contributions: Zeki SS designed and performed research; Haidry R, Justo-Rodriguez M, Lovat LB, Wright NA and McDonald SA contributed new reagents or analytic tools; Zeki SS analyzed data and wrote the paper.
Correspondence to: Dr. Sebastian S Zeki, Centre for Tumor Biology, Bart’s Cancer Institute, Charterhouse Square, London, EC1M 6BQ, United Kingdom. sebastiz@hotmail.com
Telephone: +44-207-8827205 Fax: +44-207-8827205
Received: July 9, 2013
Revised: August 23, 2013
Accepted: September 4, 2013
Published online: April 21, 2014
Processing time: 281 Days and 23.5 Hours
Abstract

Barrett’s oesophagus (BO) is a usually indolent condition that occasionally requires endoscopic therapy. Radiofrequency ablation (RFA) is an effective endoscopic treatment for high grade dysplasia (HGD) and intramucosal cancer in BO. It has a good efficacy, durability and safety profile although complications can occur. Here we describe a case of RFA in a patient with high grade dysplasia. Although the response to treatment was initially very good with the development of neosquamous epithelium, the patient very rapidly developed a squamous cell cancer of the oesophagus confirmed on radiology, histology and immunohistochemistry. Sanger sequencing confirmed that the original HGD and the squamous cell cancer (SCC) were derived from separate clonal origins. The report highlights the fact that SCC of the oesophagus has been noted after endoscopic ablation for BO previously and suggest that ablation of BO may encourage the clonal expansion of cells carrying carcinogenic mutations once a dominant clonal population has been eradicated.

Keywords: Squamous carcinoma oesophagus; Barrett’s oesophagus; Radiofrequency ablation; Squamous cell cancer; High grade dysplasia

Core tip: The development of squamous cell cancer of the oesophagus after endoscopic ablation can happen and may add further weight to the argument for continued surveillance after radiofrequency ablation for Barrett’s related pathologies.