Case Report
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World J Gastrointest Endosc. Aug 16, 2014; 6(8): 385-389
Published online Aug 16, 2014. doi: 10.4253/wjge.v6.i8.385
Lymphoepithelioma-like esophageal carcinoma with macroscopic reduction
Masaya Uesato, Tuguaki Kono, Tooru Shiratori, Yasunori Akutsu, Isamu Hoshino, Kentarou Murakami, Daisuke Horibe, Tetsurou Maruyama, Yoshihide Semba, Ryuma Urahama, Yukiko Ogura, Takashi Oide, Toru Tanizawa, Hisahiro Matsubara
Masaya Uesato, Tuguaki Kono, Tooru Shiratori, Yasunori Akutsu, Isamu Hoshino, Kentarou Murakami, Daisuke Horibe, Tetsurou Maruyama, Yoshihide Semba, Ryuma Urahama, Yukiko Ogura, Hisahiro Matsubara, Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
Takashi Oide, Toru Tanizawa, Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
Author contributions: Uesato M wrote and revised the manuscript; Uesato M, Kono T, Shiratori T, Akutsu Y, Hoshino I, Murakami K, Horibe D, Maruyama T, Semba Y, Urahama R, Ogura Y, and Matsubara H diagnosed and treated the patient; Oide T and Tanizawa T contributed to the histopathological diagnosis; and all authors discussed the results, commented on the manuscript and approved the final version.
Correspondence to: Masaya Uesato, MD, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Telephone: +81-43-2262110 Fax: +81-43-2262113
Received: February 12, 2014
Revised: April 8, 2014
Accepted: June 27, 2014
Published online: August 16, 2014
Processing time: 183 Days and 1.6 Hours
Abstract

Esophageal lymphoepithelioma-like carcinoma (LELC) is extremely rare. We report the first case of esophageal LELC showing macroscopic reduction. A 67-year-old male presented with dysphagia and, by endoscopic examination, was found to have a significantly raised tumor of 10 mm in diameter in the thoracic esophagus. The biopsied material showed esophageal cancer. We performed endoscopic submucosal dissection. However, the tumor became flattened, similar to a scar, in only 2 mo. Histologically, the carcinoma cells had infiltrated the submucosal layer. Prominent infiltration of T lymphoid cells that stained positive for CD8 was observed around the carcinoma cells. Therefore, this lesion was considered to be an LELC with poorly differentiated squamous cells. Because the margin was positive, an esophagectomy was performed. Carcinoma cells were detected in the neck in one lymph node. The staging was T1N0M1b. However, the patient has been well, without adjuvant therapy or recurrence, for more than 5 years.

Keywords: Esophageal cancer; Lymphoepithelioma-like carcinoma; Lymphoid stroma; Tumor-infiltrating lymphocyte; Cytotoxic T lymphocyte; Reduction

Core tip: The first case of esophageal lymphoepithelioma-like carcinoma showing macroscopic reduction is reported. In only 2 mo, the appearance of the esophageal tumor changed from a protruding lesion to a flat scar-like entity. After esophagectomy, one lymph node was diagnosed with metastasis. Prominent infiltration of T lymphoid cells that stained positive for CD8 was observed around the carcinoma cells. Strong expression of human leukocyte antigen-DR was evident in the cell membrane. The immune responses against the main tumor and the denatured carcinoma cells in the metastatic lymph node developed at the same time. Therefore, systemic immune responses against the carcinoma might have been occurring.