The verrucous carcinoma of the Esophagus – A rare highly differentiated squamous cell carcinoma

Background:

The verrucous carcinoma of the esophagus is a rare, very slowly growing and uncommonly metastasizing locally progressive and highly differentiated squamous cell carcinoma. The genesis of the tumor is not completely clarified but often associated with human papilloma virus or chemical toxic exposure of the mucosa. On endoscopy it appears exophytic, villous, with whitish hyperkeratosis, endosonographically pretending a uT3N+ situation. Patients often present with dysphagia and unspecific reflux symptoms. Often several biopsies of the tumor are needed to make the diagnosis, because few routinely taken standard biopsies often show unspecific inflammation or mycotic Infections. However, the carcinoma is subjacent.

Aim:

Diseases on rare occasions often need extensive diagnostic, therefore we want to call in mind the verrucous carcinoma of the esophagus.

Methods:

Small case series in a single center patient collective.

Results:

From 2010 to 2017, 55 patients underwent esophageal resection. In two patients (3,6%) a verrucous carcinoma was diagnosed. That is far more often than expected. Conclusion:

In patients with dysphagia and a macroscopic villous structure on endoscopy, further samples should be taken despite benign primary histology and a reference pathologist should be involved.