Yang XY, Fu KI, Chen YP, Chen ZW, Ding J. Diffuse xanthoma in early esophageal cancer: A case report. World J Clin Cases 2021; 9(19): 5259-5265 [PMID: 34307576 DOI: 10.12998/wjcc.v9.i19.5259]
Corresponding Author of This Article
Jing Ding, MD, Associate Professor, Chief Physician, Department of Gastroenterology and Hepatology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin Road, Jinhua 321000, Zhejiang Province, China. watbrooker@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Yun Yang, Yan-Ping Chen, Jing Ding, Department of Gastroenterology and Hepatology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
Kuang-I Fu, Department of Endoscopy, Kanma Memorial Hospital, Tokyo 325-0046, Japan
Zhen-Wei Chen, Department of Pathology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
Author contributions: Yang XY was the patient’s attending physician and was responsible for collecting the medical history, performing magnifying endoscopy, reviewing the literature, and drafting the manuscript; Fu KI analyzed and interpreted the endoscopic findings and contributed to manuscript drafting; Chen YP performed the endoscopic submucosal dissection for the patient; Chen ZW was the pathologist who gave the pathological results; Ding J reviewed the literature and contributed to revising the manuscript; all authors issued the final approval for the version to be submitted.
Supported bythe Basic Public Welfare Research Program of Zhejiang Province, China, No. LGF19H160022.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Ding, MD, Associate Professor, Chief Physician, Department of Gastroenterology and Hepatology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin Road, Jinhua 321000, Zhejiang Province, China. watbrooker@163.com
Received: February 8, 2021 Peer-review started: February 8, 2021 First decision: March 28, 2021 Revised: April 9, 2021 Accepted: May 8, 2021 Article in press: May 8, 2021 Published online: July 6, 2021 Processing time: 135 Days and 8.5 Hours
Abstract
BACKGROUND
Gastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus. To date, there have been no reports of esophageal xanthoma combined with esophageal cancer. Herein, we present the first case in the literature of a diffuse xanthoma complicated with early esophageal cancer. Moreover, this combination makes the endoscopic diagnosis difficult if it is not in mind.
CASE SUMMARY
A 68-year-old man visited our department with a 2-mo history of epigastric discomfort. He underwent surgery for gastric cancer 6 years ago. Esophagogastroduodenoscopy showed a semi-circumferential irregular yellowish-colored and granular lesion in the esophagus (30-35 cm from the incisors). Using magnifying endoscopy with narrow band imaging, aggregated minute and yellowish-colored spots with tortuous microvessels on the surface were observed, and background coloration was clearly seen in the lesion. As endoscopic biopsy suggested a histologically high-grade dysplasia; the lesion was completely resected en bloc by endoscopic submucosal dissection (ESD). The resected specimen was confirmed to be a squamous cell carcinoma in situ with extensive foamy cells in the superficial mucosal layer. Immunohistochemically, the observed foamy cells were strongly positive for CD68, which is characteristic of xanthoma. The clinical course was favorable, and no recurrence was observed 2 years and 7 mo after ESD.
CONCLUSION
Diffuse xanthoma concurrent with early esophageal cancer is extremely rare. The characteristic endoscopic features may assist endoscopists in diagnosing similar lesions.
Core Tip: Esophageal xanthomas are uncommon, non-neoplastic lesions characterized by the accumulation of foamy histiocytes. Herein, we present the first case of early esophageal cancer covered by xanthomas, diffusely and superficially treated by endoscopic submucosal dissection. Knowing these characteristic endoscopic features can help endoscopists reach a correct diagnosis for appropriate treatment.
