Published online Jul 16, 2014. doi: 10.12998/wjcc.v2.i7.284
Revised: March 23, 2014
Accepted: May 19, 2014
Published online: July 16, 2014
Verrucous carcinoma of the esophagus is a variant of a squamous cell cancer. Our case is a 78-year-old male patient comes in with the dysphagia and weight loss, and on endoscopy (EGD) he is found to have an irregular intraluminal mass at the distal esophagus. With the deep EGD assisted biopsy, diagnosis of the verrucous carcinoma is made. Due to multiple co morbidities and possible infiltration to the pericardium, patient is taken for the esophageal stent placement and is being referred for the chemo-radiation treatment. The diagnosis can be very difficult to make with the superficial biopsies due to very non specific histological changes and requires very high clinical suspicion and deep mucosal biopsies are required for accurate diagnosis of the tumor. Chronic and local disease process is the main risk factor for the development of the verrucous carcinoma of the esophagus. Surgery is the treatment of the choice for the early stage tumor and advanced cases are treated with the palliation and possibly chemo- radiation. The prognosis is usually guarded and needs long term follow up.
Core tip: A verrucous carcinoma is a slow growing, well differentiated, rare form of squamous carcinoma variant. It is associated with chronic, local disease process and it invades locally. On endoscopy (EGD), it appears as an exophytic irregular warty projecting mass, and it is very difficult to diagnose by superficial biopsy due to non specific superficial histological findings. So it requires high index of suspicion and deep biopsy with EGD or endoscopic ultrasonography (EUS). It projects as hypoechoic mucosal thickening on EUS. Early stages of cancers are treated surgically. Advanced cases can be referred for esophageal stent placement for palliation and chemo radiation. It has high morbidity and mortality and requires long term follow up for accurate numbers regarding to the treatment and the follow up.