Cases reported "Carcinoma in Situ"

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1/21. Rapid-growing carcinosarcoma of the esophagus arising from intraepithelial squamous cell carcinoma: report of a case.

    A case of carcinosarcoma arising from the intraepithelial spreading area of esophageal squamous cell carcinoma (SCC) is reported herein. A 64-year-old man was referred to our hospital for investigation of a sore throat and dysphagia. An endoscopic examination revealed a 2. 5-cm polypoid mass in the mid-esophagus. Esophagograms taken 1 month prior to consultation by our hospital and just before surgery revealed marked change within a period of less than 2 months from a 2-cm sessile elevated mass to a 4-cm polypoid mass with a lobular appearance. The resected specimen contained two lesions in the esophagus. The larger one measured 4.0 x 2.0 x 2.0 cm and had a pedunculated polypoid shape, while the smaller one, measuring 1 cm in diameter, was a plateau-type elevated lesion located 3 cm distal from the larger mass. Histologically, the distal smaller lesion was diagnosed as primary SCC associated with a high frequency of intraepithelial spread, while the larger polypoid mass was composed of spindle-shaped sarcomatous cells, arising from the intraepithelial spread of SCC. To our knowledge, this is the only reported case of esophageal carcinosarcoma arising from an area of intraepithelial spread of SCC that showed such surprisingly rapid growth.
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2/21. Atypical melanocytic proliferation associated with squamous cell carcinoma in situ of the esophagus.

    We present the case of a 64-year-old woman who underwent a transhiatal esophagectomy subsequent to the presence of high-grade dysplasia of the esophageal squamous epithelium in repeated biopsies. In the resection specimen chronic esophagitis and multifocal carcinoma in situ of the squamous epithelium were diagnosed, associated with a diffuse intraepithelial proliferation of melanocytic cells. While melanocytic hyperplasia (melanocytosis) has previously been recognized as an occasional reactive lesion that can accompany esophageal inflammation and invasive squamous carcinoma, the present case was unusual because of its cytonuclear and architectural atypia in the melanocytic cell population, resembling features of a melanoma in situ in the absence of manifest invasive malignant melanoma. The disappearance of the melanocytic lesion during follow-up supports its nonneoplastic nature, however. This case illustrates that 'malignant features' in esophageal melanocytosis should be interpreted with caution.
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3/21. Intraepithelial carcinoma of the oesophagus: report of 25 cases from north-east italy.

    OBJECTIVE: To investigate the incidence and define the diagnostic aspects of intraepithelial squamous cell carcinoma of the oesophagus and to show the trend in its natural history. DESIGN: Analysis of records of more than 31000 upper gastrointestinal endoscopies in a secondary referral centre. SETTING: gastroenterology unit, italy. SUBJECTS: 23 men and 2 women with endoscopic and histological diagnoses of intraepithelial squamous cell carcinoma of the oesophagus. RESULTS: The incidence was 0.8/1000 patients/year. There was a coexisting oropharyngeal or laryngeal cancer in 17 patients. The endoscopic appearance was of a more or less well-defined hyperaemic area. Lesions progressed to infiltrating carcinoma in a mean of 18.3 months range 11-32). CONCLUSIONS: Intraepithelial squamous cell carcinoma is rare in this population. endoscopy and histology are essential for diagnosis and staging.
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4/21. Paget's disease of the oesophagus associated with mucous gland carcinoma of the lower oesophagus.

    AIM: To report a rare case of oesophageal Paget's disease and its rarer combination with submucosal gland carcinoma of the lower oesophagus. methods AND RESULTS: A 74-year-old Saudi female was admitted with the complaint of dysphagia. Endoscopic examination showed an ulcerated tumour at the gastro-oesophageal junction. Initial biopsy showed an undifferentiated carcinoma with pagetoid spread in the oesophageal stratified squamous epithelium. Oesophago-gastrectomy specimen showed a lobulated, poorly differentiated mucous gland carcinoma at the gastro-oesophageal junction. The tumour showed focal acinar differentiation and obvious cancerization of the submucosal glands, somewhat similar to the breast lobular carcinoma in situ. One of the isolated and cancerized submucosal glands also showed carcinoma in situ of its duct. Oesophageal surface epithelium showed extensive pagetoid spread, both over and away from the main tumour. The pagetoid tumour cells showed selective positivity for cytokeratin 7, cytokeratin Cam 5.2, BerEP4 and to a lesser extent for CEA. CONCLUSIONS: As far as we know, this is the fifth case report of oesophageal Paget's disease and the first report of its association with the underlying mucous gland carcinoma.
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5/21. adenocarcinoma in situ arising from the submucosal oesophageal mucous glands.

    The incidence of adenocarcinoma of the oesophagus is increasing; this type of carcinoma commonly arises on Barrett's oesophagus. We report a case of in-situ adenocarcinoma of the lower oesophagus arising in submucosal oesophageal mucous glands without intestinal metaplasia. We describe the histological findings, discuss the difficulties of differentiating this from invasive disease and review the current literature regarding this rare condition.
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6/21. Superficial esophageal carcinoma in achalasia, detected by endoscopic surveillance.

    A 42 year old woman had undergone a Heller myotomy for achalasia of the cardia at age 28. Thereafter, she had become asymptomatic but reported for endoscopic follow-up examinations at three-yearly intervals. Fourteen years after surgery, endoscopy and biopsy revealed "carcinoma in situ" in the proximal esophagus and surgery was recommended. In the resected specimen, a circumscribed area of cancer was demonstrated that invaded the lamina propria but was confined to the mucosa. With the exception of mild and transient postoperative dysphagia, she had an uneventful postoperative course and remains well 16 months following surgery. This case demonstrates that endoscopic surveillance may detect early malignant changes in the achalasic esophagus and may possibly lead to an improvement in survival.
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7/21. Endoscopic resection of carcinoma in situ of the esophagus accompanied by esophageal varices.

    A case of carcinoma in situ of the esophagus accompanied by esophageal varices was treated by endoscopic mucosal resection using a transparent tube (EMRT) following eradication of the varices via injection sclerotherapy (EIS). Intravariceal injection sclerotherapy was performed for esophageal varices, and after eradication of the varices had been achieved, half of the circumferential esophageal mucosal resection of the cancer lesion was carried out. No serious complication such as perforation or mass bleeding was observed. Cancer-involved mucosa was completely resected and all specimens contributed well to accurate histopathological study, being diagnosed as intraepithelial squamous-cell carcinoma. The artificial ulcer recovered completely, showing no stenotic changes. Our conclusion from this experience is that EIS EMRT is a valuable and minimally invasive treatment for patients exhibiting this disease, providing an accurate histological diagnosis.
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8/21. Malignant transformation of esophageal columnar epithelium.

    This report describes two patients with esophageal columnar epithelium (Barrett's esophagus) in which microinvasive adenocarcinoma developed. Case 1 had multiple foci of carcinoma in situ contiguous with epithelium resembling gastric and intestinal mucosa. Case 2 had signet-ring type adenocarcinoma. Surveillance for malignant transformation in columnar esophageal epithelium should be routinely performed, and because of its focal nature, multiple biopsies and cytologic examination should be carried out. The presence of carcinoma in situ should lead to consideration of excision of the affected esophagus.
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9/21. Small cell carcinoma (non-oat cell type) of the esophagus concomitant with invasive squamous cell carcinoma and carcinoma in situ. A case report.

    A case of double primary invasive carcinoma of the esophagus, consisting of well-differentiated squamous cell carcinoma and non-oat cell small cell carcinoma without squamous differentiation, is presented. This is the first reported case of a double or multiple primary invasive carcinoma of the esophagus in which one component is small cell carcinoma (oat cell or non-oat cell). Furthermore, the mucosal epithelium around the non-oat cell small cell carcinoma revealed multiple dysplasia and carcinoma in situ. These lesions were definitely separated from the invasive carcinoma and from each other. The results suggest that pure non-oat cell small cell carcinoma of the esophagus without squamous differentiation is derived from the esophageal squamous epithelium, and is a variant of squamous cell carcinoma.
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10/21. Rapid growth of a pseudosarcoma of the esophagus.

    The growth of a pseudosarcoma of the esophagus was observed chronologically by serial esophagography. Esophagograms taken 12 and 6 months prior to diagnosis showed no abnormalities. At diagnosis, the tumor in the lower esophagus had a polypoid and nodular surface with a stalk, and it was approximately 3 cm in diameter. Four months later, the tumor had increased in size to 4 cm in diameter. The tumor was 5 cm in length and incarcerated into the stomach with an elongated stalk at operation. The growth curve was linear on semilogarithmic paper; its doubling time was calculated as 2.2 months. The surgical specimen showed squamous cell carcinoma and spindle cell sarcoma-like elements that comprised the greater part of the tumor. The sarcoma-like elements had metastasized to the abdominal lymph nodes. These findings confirm that this polypoid tumor grows rapidly.
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