Gastrointestinal Pathology I Case Studies


CASE 1: Esophageal squamous cell carcinoma


Clinical History:

A 62-year-old man had a 2 month history of increasing difficulty swallowing. He found it more difficult to eat, and he had lost 5 kg during this time. He also had a history of both alcohol abuse and cigarette smoking. On upper GI endoscopy a mass lesion was seen (image 1.1). Surgery was performed. The mass is shown in image 1.2 in the esophagectomy specimen. It was 3 cm in diameter and appeared to extend through the muscular wall. On the surface it was ulcerated. The low and high power microscopic appearances are shown in images 1.3 and 1.4.
  1. What is the diagnosis?

    2. This is squamous cell carcinoma of the esophagus.

  2. What are typical presenting symptoms?

    3. Typical symptoms include dysphagia, pain, and weight loss. Less commonly, patients may have hemorrhage or may have aspiration from difficulty swallowing.

  3. What are contributing factors for development of this lesion?

    4. Smoking and alcoholism are predisposing factors in the U.S. and developed nations. Overall, men are more frequently affected than women and Blacks more than whites. Food contaminated with Aspergillus or foods rich in nitrites or nitrosamines, molybdenum and zinc deficiencies, esophageal stricture, and esophageal web are also implicated (anything leading to chronic esophagitis).

  4. What is the prognosis?

    5. The prognosis is very poor (<10% 5 year survival) because most of theses cancers are not detected early.