Diffuse xanthoma in early esophageal cancer: A case report

Figure 1 Endoscopic illustrations (GIF-H260Z, Olympus). A: White light endoscopy showed a semi-circumferential, irregular, yellowish-colored, and granular lesion localized in the middle and lower esophagus (orange arrow); B: Narrow band imaging endoscopy revealed aggregation of minute yellowish spots with tortuous microvessels inside; C: Type B1 intrapapillary capillary loops were identified by magnifying endoscopy in the region around the yellow spots, and the lesion was positive for background coloration (orange arrow); D: Lugol's iodine staining revealed a well-demarcated unstained lesion (orange arrow).

Figure 2 Macroscopic findings. A: Lugol's iodine staining of the specimen revealed that the tumor was removed en bloc by endoscopic submucosal dissection; B: Diffuse yellowish-colored lesion was recognized in this fixed specimen (orange arrow); C: The size of the specimen is 45 × 33 mm. The yellow line indicates the esophageal xanthoma. The red line demonstrates squamous cell carcinoma in the superficial mucosal layer.

Figure 3 Histopathological findings. Hematoxylin and eosin staining of the lesion showed squamous cell carcinoma in situ in which extensive foam cells were seen in the superficial mucosal layer. A: Magnification × 5; B: Magnification × 20.

Figure 4 Immunohistochemical findings. A and B: Immunohistochemical staining showed that the regions of squamous cell carcinoma were positive for P53 and negative for P16 (× 20); C: The Ki-67 index was 90% (× 20); D: The observed foam cells were strongly positive for CD68 (× 20).

Figure 5 White light endoscopy showed no stricture and local recurrence 24 mo after endoscopic submucosal dissection.