Esophageal verrucous carcinoma arising from hyperkeratotic plaques associated with human papilloma virus type 51
Esophageal verrucous carcinoma arising from hyperkeratotic plaques associated with human papilloma virus type 51
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DOI：
10.1111/j.1442-2050.2010.01087.x
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发表时间：
2010-01-01
影响因子：
2.6
通讯作者：
Ladabaum, U.
中科院分区：
文献类型：
--
作者：
Tonna, J.;Palefsky, J. M.;Ladabaum, U.
食管疣状癌是食管鳞状细胞癌的一种罕见变异型.我们报告一个与人类乳头状瘤病毒51型相关的食道疣状癌病例。患者长期存在吞咽困难和吞咽痛，活检显示白色食管斑块角化过度。在重复内镜检查时，食管被疣状白色斑块和带有白色叶状物的结节状粘膜区域覆盖，远端10 cm光滑肿块突出到管腔中。活检显示非典型鳞状细胞增生性病变，但没有明确的恶性肿瘤。用聚合酶链反应检测内镜活检标本中HPV 51型DNA。由于病变的大小有利于潜在的疣状癌，我们的病人接受了微创食管切除术与胃拉起和颈部吻合。病理诊断为高分化的食管疣状癌。食管切除术后一年，患者感觉良好，无疾病。虽然在手术获得的癌组织中没有检测到HPV DNA，但我们的病例表明HPV 51型与食管疣状癌之间存在关联。本病例的临床进展强调了内镜监测在食管角化过度患者中的重要性，当怀疑恶性肿瘤时，即使浅表活检未显示明显恶性肿瘤，也应进行明确的手术切除。
P>Esophageal verrucous carcinoma is a rare variant of esophageal squamous cell carcinoma. We report a case of esophageal verrucous carcinoma associated with human papilloma virus (HPV) type 51. The patient had long-standing dysphagia and odynophagia, and white esophageal plaques showing hyperkeratosis on biopsy. At repeat endoscopy, the esophagus was covered with verrucous white plaques and areas of nodular mucosa with white fronds, with a distal 10-cm smooth mass protruding into the lumen. Biopsies demonstrated an atypical squamoproliferative lesion but no frank malignancy. HPV type 51 DNA was detected in endoscopic biopsy specimens by polymerase chain reaction. Because the size of the lesion favored an underlying verrucous carcinoma, our patient underwent minimally invasive esophagectomy with gastric pull-up and cervical anastomosis. The pathologic diagnosis was a well-differentiated esophageal verrucous carcinoma. One year after esophagectomy, the patient feels well and is free of disease. Although HPV DNA was not detected in the cancer tissue obtained at surgery, our case suggests an association between HPV type 51 and esophageal verrucous carcinoma. The clinical evolution in this case highlights the importance of endoscopic surveillance in patients with exuberant esophageal hyperkeratosis, and of definitive surgical resection when malignancy is suspected even if frank malignancy is not demonstrated on superficial biopsies.