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Vol. 81. Issue 3.
Pages 176-178 (July - September 2016)
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6728
Vol. 81. Issue 3.
Pages 176-178 (July - September 2016)
Scientific letter
Open Access
Multiple and synchronous squamous cell carcinoma of the esophagus in a young woman: An example of early and rapid carcinogenesis?
Carcinoma epidermoide de esófago múltiple y sincrónico en una mujer joven: ¿un ejemplo de carcinogénesis temprana y rápida?
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R.A. Silva-Silvaa, Z.R. Romero-Amaroa,b, L.A. Linares-Larrazabala, G.J. Arismendi-Morilloa,c,
Corresponding author
gabrielarismendi@gmail.com

Corresponding author: Servicio y Postgrado de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Instituto de Investigaciones Biológicas, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela. Phono: +582617597250.
a Servicio de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo, Venezuela
b Cátedra de Citopatología, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela
c Instituto de Investigaciones Biológicas, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela
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Tumor multicentricity is occasionally observed in esophageal squamous cell carcinoma.1–3 It is linked to genetic instability of the p53 gene, added to the loss of heterozygosity, as early events of the carcinogenesis of multifocal or multiple squamous cell carcinoma of the esophagus,4,5 and to risk factors associated with the environment and lifestyles.2,6

Case presentation

A 47-year-old woman, who was a heavy smoker for more than 20 years, sought medical attention for moderately intense, continuous retrosternal chest pain of 3-month progression that was exacerbated by food intake, and for dysphagia with solid foods, and weight loss. Physical examination revealed tachycardia, dyspnea, cachexia, and bad teeth. Upper gastrointestinal endoscopy study identified the presence of 2 lesions with a tumor-like aspect in the middle and lower third of the esophagus. They exhibited an elevated level of annular and stenosing plaque growth, respectively (Fig. 1). Afterwards, transhiatal esophagectomy through left cervicotomy was performed. The pathology study reported well differentiated multiple squamous cell carcinoma with annular stenosing growth infiltrating up to the periesophageal fibroadipose tissue with moderately differentiated squamous cell carcinoma foci at the level of the serosa and periesophageal tissue, regional lymph node metastasis, and multifocal lymphatic and blood vascular invasion (Fig. 2). The patient had satisfactory postoperative progression.

Figure 1.

A) Tumor in the middle third, showing increased plaque growth. B) Tumor in the lower third showing elevated annular and stenosing growth.

(0.14MB).
Figure 2.

A) Segment of the middle and distal esophagus showing tumor formation with annular and infiltrative growth up to the serosa that almost completely obstructs its lumen. B and C) Squamous cell carcinoma with intercellular bridges, corneal pearls, dyskeratotic cells, and atypical mitoses. D) Lymph node metastasis. E) Areas of periesophageal tissue with neoplastic nodules of moderately differentiated squamous cell carcinoma (with no intercellular bridges, corneal pearls, or keratin (H&E stain).

(0.47MB).

This is a very unusual case in a young woman, a heavy smoker, presenting with multifocal squamous cell carcinoma. It contrasts with the habitual esophageal squamous cell carcinoma predominantly observed in men above 60 years of age. The particular circumstance of this patient could be linked to the possible coexistence of genetic instability of the p53 gene, added to the marked and prolonged smoking habit. Mutations in the p53 gene, together with the loss of heterozygosity, constitute early events of multiple step esophageal carcinogenesis of multiple primary squamous cell carcinoma.4,7,8 In addition, the marked and prolonged smoking habit is also closely related to the events of multicentric carcinogenesis in the upper gastrointestinal tract, including the esophagus.6 Saeki et al.9 established the fact that cigarette smoking is clearly associated with an increased frequency in the accumulation of the p53 protein in cases of multiple primary squamous cell carcinoma. Consequentially, this mixture could solidify early and rapid carcinogenesis, with the subsequent development of multifocal squamous cell carcinoma, as observed in the present case.

Financial disclosure

No financial support was received in relation to this article.

Conflict of interest

The authors declare that there is no conflict of interest.

References
[1]
U. Robeiro, I. Cecconello, A. Safatle-Ribeiro, et al.
Squamous cell carcinoma of the esophagus and multiple primary tumors of the upper aerodigestive tract.
Arq Gastroenterol, 36 (1999), pp. 195-200
[2]
H. Kuwano, S. Ohno, H. Matsuda, et al.
Serial histologic evaluation of multiple primary squamous cell carcinomas of the esophagus.
Cancer, 61 (1988), pp. 1635-1638
[3]
C. Katada, M. Muto, S. Tanabe, et al.
Factors associated with the presence of multiple Lugol-voiding lesions in patients with esophageal squamous-cell carcinoma.
Dis Esophagus, 27 (2014), pp. 457-462
[4]
T. Fujiki, S. Haraoka, S. Yoshioka, et al.
p53 Gene mutation and genetic instability in superficial multifocal esophageal squamous cell carcinoma.
Int J Oncol, 20 (2002), pp. 669-679
[5]
S. Ito, T. Ohga, H. Saeki, et al.
p53 mutation profiling of multiple esophageal carcinoma using laser capture microdissection to demonstrate field carcinogenesis.
Int J Cancer, 113 (2005), pp. 22-28
[6]
M. Morita, R. Kumashiro, N. Kubo, et al.
Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: Epidemiology, clinical findings, and prevention.
Int J Clin Oncol, 15 (2010), pp. 126-134
[7]
S.T. Shi, G.Y. Yang, L.D. Wang, et al.
Role of p53 gene mutations in human esophageal carcinogenesis: Results from immunohistochemical and mutation analyses of carcinomas and nearby non-cancerous lesions.
Carcinogenesis, 20 (1999), pp. 591-597
[8]
H. Seaki, H. Kitao, K. Yoshinaga, et al.
Copy-neutral loss of heterozygosity at the p53 locus in carcinogenesis of esophageal squamous cell carcinomas associated with p53 mutations.
Clin Cancer, 17 (2011), pp. 1731-1740
[9]
H. Saeki, S. Ohno, M. Miyazaki, et al.
p53 protein accumulation in multiple oesophageal squamous cell carcinoma: Relationship to risk factors.
Oncology, 62 (2002), pp. 175-179

Please cite this article as: Silva-Silva RA, Romero-Amaro ZR, Linares-Larrazabal LA, Arismendi-Morillo GJ. Carcinoma epidermoide de esófago múltiple y sincrónico en una mujer joven: ¿un ejemplo de carcinogénesis temprana y rápida? Revista de Gastroenterología de México. 2016;82:176–178.

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