case_images: PMC10761477_01
case_images: (A) Endoscopic image of the upper third esophageal stenosis. (B) Endoscopic image of the fibrous ring in the cervical esophagus.
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case_images: F1
case_images: Due to clinical worsening with high dysphagia to solids and liquids and dysphonia, a new endoscopic study was performed in October 2020, which showed a semicircular substenosis just below the upper esophageal sphincter (Figure 1A) that did not allow the passage of a 12 mm endoscope but only a 10 mm instrument. A new endoscopy was performed in November 2021, which described a passable cervical fibrous ring (Figure 1B) and a fibrotic distal esophagus that was biopsied, resulting in moderate dysplasia of the squamous epithelium without an increase in eosinophils.
case_images: (C-E) Endoscopic images of esophageal rings, longitudinal stripes, and whitish network-like mucosa. (F, G) Endoscopic images in narrow band imaging (NBI) showing vascular changes.
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case_images: PMC10761477_01_fmed-10-1233566-g0002.jpg
case_images: F2
case_images: In subsequent endoscopic examinations (August and November 2022), previously unreported esophageal changes were observed, such as a decrease in lumen caliber, generalized trachealized rings (Figure 2C), longitudinal striations (Figure 2D), a new stenosis at 18 cm from the dental arch that is endoscopically dilated, erosions and friability, and a white "reticular-like" or atrophic-looking mucosa (Figure 2E), with abnormal vascular changes and pinpoint vessels along the entire esophageal path (Figures 2F, G).
case_images: (H) HE x 40 staining. Endoscopic biopsy contains only the superficial squamous epithelium, showing intraepithelial lymphocytes predominantly in the lower layers, as well as "Civatte bodies" (highlighted). (I) HE x 20 staining. Esophageal squamous dysplasia, high grade with isolated focus, probably representing dysplastic involvement of submucosa gland ducts.
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case_images: F3
case_images: The presence of occasional dyskeratinocytes or apoptotic eosinophilic bodies (known as "Civatte bodies") were also noted (Figure 3H). A new gastroscopy was performed (February 2023) and biopsies from the middle and distal esophagus showed intraepithelial squamous neoplasia (high-grade dysplasia, Figure 3I).
case_images: (J) A macroscopic picture of the surgical specimen, which shows the esophagus and the gastroesophageal union. The whole esophageal mucosa shows an irregular surface, with violaceous areas alternating with paler zones, as well as occasional punctate depressions corresponding to superficial erosions. (K) HE x 40 staining. Section from the surgical specimen showing esophageal mucosa with abrupt transition from lichenoid changes to frank dysplasia (L) PAS-diastase x55 staining. This complementary technique highlights the eosinophilic "Civatte bodies" at high magnification, in addition to hydropic degeneration of the basal cells. (M) HE x 40 staining. View of high-grade dysplasia with an increased number of mitoses, some of them atypical and located in upper layers of the epithelium.
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case_images: F4
case_images: The pathology report of the surgical specimen indicates high-grade dysplasia on a focally ulcerated lichenoid esophagitis without signs of invasion (Figures 4J-M).