Ekinci Nese, Gün Eylül, Aslan Fatih
Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, IZMIR, TURKEY.
Turk Patoloji Derg. 2020;36(1):73-76. doi: 10.5146/tjpath.2018.01447.
Seborrheic keratosis, one of the most common lesions of the epidermis, is rarely seen on mucosal surfaces. We report a case of a distinctive epithelial neoplasm of the esophagus showing close resemblance to seborrheic keratosis that was resected with endoscopic submucosal dissection. A 65-year-old patient's previous esophageal biopsy showed suspicious low grade dysplasia and the patient was referred for endoscopic submucosal dissection of a flat lesion in the mid-esophagus. Macroscopic examination revealed a well circumscribed, pigmented and elevated lesion with a diameter of 20 mm. Microscopically, the lesion was well circumscribed, with plaque-like elevation, and showed hyperkeratosis, acanthosis, and papillomatosis. Broad coalescing solid sheets and interconnecting trabeculae of basaloid cells were the consistent feature throughout the lesion. Squamous eddies and occasional central keratinization were present. Mitotic activity and koilocytes were not identified. Immunohistochemically, the lesion showed diffuse nuclear positivity with p63 and negativity with p16. Ki-67 index was confined to the basal cell layer. With the help of histopathologic and immunohistochemical findings, we diagnosed this morphologically benign case as "seborrheic keratosis-like lesion of the esophagus". It should be kept in mind that seborrheic keratosis-like lesions might be rarely seen on mucosal surfaces such as the esophagus. Endoscopic submucosal dissection is a new, curative, and safe endoscopic resection technique in en-bloc resection of superficial esophageal lesions. To our knowledge, this is the first case of the aforementioned lesion in the esophagus being resected with endoscopic submucosal dissection.
脂溢性角化病是表皮最常见的病变之一，在黏膜表面很少见。我们报告一例食管独特的上皮性肿瘤，其与脂溢性角化病极为相似，经内镜黏膜下剥离术切除。一名65岁患者之前的食管活检显示可疑的低级别发育异常，该患者因食管中段扁平病变接受内镜黏膜下剥离术。肉眼检查发现一个边界清晰、色素沉着且隆起的病变，直径为20毫米。显微镜下，病变边界清晰，呈斑块状隆起，表现为角化过度、棘层肥厚和乳头瘤样增生。整个病变中一致的特征是基底样细胞形成宽阔融合的实性片层和相互连接的小梁。可见鳞状涡旋和偶尔的中央角化。未发现有丝分裂活性和空泡细胞。免疫组化显示，病变p63弥漫性核阳性，p16阴性。Ki-67指数局限于基底细胞层。借助组织病理学和免疫组化结果，我们将这个形态学上良性的病例诊断为“食管脂溢性角化病样病变”。应牢记，脂溢性角化病样病变在食管等黏膜表面可能很少见。内镜黏膜下剥离术是一种用于整块切除浅表食管病变的新型、治愈性且安全的内镜切除技术。据我们所知，这是首例采用内镜黏膜下剥离术切除上述食管病变的病例。
