case_images: PMC11785629_01
case_images: The endoscopic image from 8 years ago of the site where the tumor was localized. The endoscopic image from 8 years ago did not reveal any tall elevated lesion. a Panoramic view of the stenotic area. b A close-up image of the stenotic area reveals a whitish, flat elevation on the oral side of the stenosis
case_images: 12328_2024_2042_Fig1_HTML.jpg
case_images: PMC11785629_01_12328_2024_2042_Fig1_HTML.jpg
case_images: Fig1
case_images: Tokyo, Japan) (Fig. 1). Thirteen endoscopic balloon dilations (EBDs) of the stenoses were performed in April 2013.
case_images: Endoscopic findings of esophageal stenosis observed 2 years before endoscopic treatment when the patient presented again with dysphagia
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case_images: PMC11785629_01_12328_2024_2042_Fig2_HTML.jpg
case_images: Fig2
case_images: This revealed a three-quarters circumferential white-toned, elevated lesion at 25-30 cm from the upper incisor dentition, with a flat elevation on the oral side, a taller elevation on the anal side, and narrowing of the lumen in the region (Fig. 2).
case_images: Endoscopic findings of the lesion at endoscopic submucosal dissection. a Panoramic view of the lesion. b A close-up image of the lesion. In the lesion, a whitish, high-evaluated area and a squamous, flat elevated area are observed. c The high-evaluated area was stenotic. With a thin-diameter endoscope, a fringed keratinized substance is observed on the elevated area. d This lesion exhibits mild to lack of staining with Lugol's iodine
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case_images: PMC11785629_01_12328_2024_2042_Fig3_HTML.jpg
case_images: Fig3
case_images: In the same month, EGD showed a complete circumferential white keratinizing epithelium with thick furrowing at 21-30 cm, a flat elevated white adherence at 25 cm from the incisors, and narrowing from 28 to 30 cm from the incisors, which did not allow passage of a normal-diameter scope (Fig. 3).
case_images: Macroscopic and pathological findings of endoscopic submucosal dissection (ESD) specimens. a The tumor was resected in a tubular fashion using ESD. b Gross finding after formalin fixation following ESD. c Iodine-stained findings of the resected specimen by ESD. d Histopathological findings of the elevated area (low magnification view). e At the margin of the elevated area, a distinctly separated thickened keratin layer and granular layer are observed, and these layers are clearly demarcated (low magnification view). f Exophytic and papillary proliferation of low-grade tumor cells within the stratified squamous epithelium is observed. g Immunohistochemical findings for p53: p53-positive staining is observed in a subset of tumor cells
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case_images: PMC11785629_01_12328_2024_2042_Fig4_HTML.jpg
case_images: Fig4
case_images: The biopsy results showed no evidence of malignancy; however, the lesion was considered the cause of dysphagia; therefore, it was resected en bloc by endoscopic submucosal dissection (ESD) (Fig. 4a-c). Some of these layers were delaminating (Fig. 4d-f). Immunohistochemistry of this lesion showed positive results for p53, localized to the tumor area of the moderately differentiated component (Fig. 4g).