case_images: PMC6489027_01
case_images: Esophagogastroduodenoscopy revealed the presence of a slightly elevated lesion at the lower part of the esophagus. a On white light imaging, the lesion was approximately 10 mm in size, and the center of the lesion was slightly depressed and coarse, while the peripheral elevated part was covered by smooth epithelium. b The central depression was not stained by iodine. c On narrow-band imaging, the lesion did not show a well-demarcated brownish area.
case_images: crg-0013-0144-g01.jpg
case_images: PMC6489027_01_crg-0013-0144-g01.jpg
case_images: F1
case_images: On white light imaging (WLI), the lesion was approximately 10 mm in size, and the central depression was coarse, while the peripheral elevated area was smooth like a submucosal tumor (SMT) (Fig. 1a). Although the central depression was not stained by iodine (Fig. 1b), it did not show a well-demarcated brownish area on narrow-band imaging (NBI) (Fig. 1c).
case_images: a On magnifying endoscopy with narrow-band imaging, no irregularity of the microvessels was evident in the depressed area. b Only reticular pattern (Type R) vessels were detected in the center of the depressed area. c Endoscopic ultrasonography revealed a hypoechoic mass located mainly in the submucosa. It did not disrupt the submucosal layer completely.
case_images: crg-0013-0144-g02.jpg
case_images: PMC6489027_01_crg-0013-0144-g02.jpg
case_images: F2
case_images: On magnifying endoscopy with NBI (ME-NBI), reticular pattern (Type R) vessels, as reported by the Japan Esophageal Society (JES), were detected in the central depression, whereas no irregularity of the surrounding microvessels was evident (Fig. 2a, b). Additional endoscopic ultrasonography (EUS) revealed a hypoechoic mass located mainly in the submucosa, which did not disrupt the submucosal layer completely (Fig. 2c).
case_images: a Specimen resected by endoscopic mucosal resection using a cap-fitted endoscope (EMRC). b Low-power view of specimen No. 9. Almost all invasive carcinomas were covered by non-invasive intraepithelial neoplasia, whereas a small erosion was seen in the center of the lesion. c Low-power view of specimen No. 10. The surface of this specimen was somewhat damaged by the procedure of EMRC, and part of the superficial intraepithelial neoplasia was thought to be lost. d-f High-power view of specimens No. 9 and No. 10 revealed that the invasive carcinoma formed nested and ductal structures under the intraepithelial neoplasia, and they were diagnosed as adenosquamous carcinoma based on the Japanese Classification of Esophageal Cancer, 11th Edition.
case_images: crg-0013-0144-g03.jpg
case_images: PMC6489027_01_crg-0013-0144-g03.jpg
case_images: F3
case_images: Almost all of it was covered by non-invasive intraepithelial neoplasia, whereas a small erosion was seen in the central depressed area. (Fig. 3).
case_images: Immunohistological findings of carcinoma are shown. a-d The ductal structure showed positive staining for p63, CK14, CAM5.2, and EMA. e There was no substance-like basal layer with PAS staining. f Negative staining for Rabbit IgG was shown as negative control.
case_images: crg-0013-0144-g04.jpg
case_images: PMC6489027_01_crg-0013-0144-g04.jpg
case_images: F4
case_images: Immunohistologically, the ductal structure showed positive staining for p63, CK14, CAM5.2, and EMA, and there was no substance like basal layer with PAS staining (Fig. 4).