Murakami Daisuke, Harada Hideaki, Yamato Masayuki, Amano Yuji
Department of Gastroenterology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Gut Pathog. 2021 Apr 16;13(1):24. doi: 10.1186/s13099-021-00418-4.
Cytomegalovirus (CMV)-associated gastrointestinal diseases usually occur in immunocompromised patients; however, few cases has also been described in healthy hosts despite still unclear pathological mechanisms. CMV esophagitis causes various lesions, such as erythematous mucosa, erosions, and ulcers, although such inflammatory changes can appear in superficial esophageal cancers or in surrounding areas. CMV-associated esophagitis has been also reported in cancer patients, but typically in those with advanced and/or terminal stage cancers secondary to chemoradiotherapy-induced immunosuppression or the physiologic demands of the malignancy itself. To our best knowledge, we firstly report on an immunocompetent patient subject to endoscopic submucosal dissection (ESD) for early esophageal cancer complicated with CMV infection.
A 77-year-old man underwent esophagogastroduodenoscopy (EGD) at a local clinic. EGD revealed a lugol-unstained reddish lesion with whitish exudates in the middle-distal esophagus. Histological evaluation of lesion biopsy revealed atypical squamous epithelium with CMV-positive granulation tissue and aggregates of macrophages, prompting referral for further examination and treatment. Magnifying endoscopy with narrow-band imaging showed an erosive lesion with white moss in a well-demarcated brownish area with irregular mesh-like microvessels. ESD was performed for diagnosis and treatment. Histopathological examination of the resected specimen revealed superficial, moderately differentiated squamous cell carcinoma (SCC) with multiple lymphatic infiltration, and few CMV-positive cells were found in the erosive part of the SCC. Interestingly, he had no underlying conditions to predispose to CMV infection and no risk factors for esophageal cancer, other than gender and age. He received neither steroids for stricture prevention nor antiviral agents post-EGD and 4-month follow-up was negative for esophagitis.
This is the first report of a case of CMV esophagitis superimposed on early esophageal cancer in an immunocompetent host and might provide valuable information for possible adverse effects of steroid administration during ESD procedures, despite their common use for prevention of post-ESD stricture.
巨细胞病毒（CMV）相关的胃肠道疾病通常发生在免疫功能低下的患者中；然而，尽管病理机制尚不清楚，但在健康宿主中也有少数病例被描述。CMV食管炎可引起各种病变，如黏膜红斑、糜烂和溃疡，尽管这种炎症变化也可出现在浅表食管癌或其周围区域。CMV相关食管炎在癌症患者中也有报道，但通常发生在晚期和/或终末期癌症患者中，继发于放化疗引起的免疫抑制或恶性肿瘤本身的生理需求。据我们所知，我们首次报道了一名免疫功能正常的患者因早期食管癌接受内镜黏膜下剥离术（ESD）并发CMV感染。
一名77岁男性在当地诊所接受了食管胃十二指肠镜检查（EGD）。EGD显示食管中下段有一个不染碘的红色病变，中间有白色渗出物。病变活检的组织学评估显示非典型鳞状上皮伴有CMV阳性肉芽组织和巨噬细胞聚集，促使患者转诊接受进一步检查和治疗。窄带成像放大内镜显示在一个边界清晰的褐色区域有一个糜烂性病变，有白色苔，伴有不规则网状微血管。进行ESD以进行诊断和治疗。切除标本的组织病理学检查显示为浅表性、中分化鳞状细胞癌（SCC），有多处淋巴浸润，在SCC的糜烂部分发现少量CMV阳性细胞。有趣的是，除了性别和年龄外，他没有易患CMV感染的基础疾病，也没有食管癌的危险因素。他在EGD后既没有接受预防狭窄的类固醇药物，也没有接受抗病毒药物，4个月的随访显示食管炎为阴性。
这是首例免疫功能正常宿主中CMV食管炎叠加早期食管癌的病例报告，尽管类固醇药物常用于预防ESD术后狭窄，但该病例可能为ESD手术期间类固醇给药的潜在不良反应提供有价值的信息。
