Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1663-1665
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1663
High-grade dysplasia, restricted to the basal cell layer involving the entire esophagus
Mario Sarbia, Stefan Wolfer, Diana Karimi, Albert Eimiller
Mario Sarbia, Diana Karimi, Pathology Munich-North, 80992 Munich, Germany
Stefan Wolfer, Practice for Diagnostic Endoscopy in Stomach and Gut Diseases, 80796 Munich, Germany
Albert Eimiller, Clinic for Gastrointestinal Diseases, 80331 Munich, Germany
Author contributions: Wolfer S and Eimiller A substantially contributed to the acquisition and analysis of data; Karimi D analyzed the data and contributed to the acquisition of data; Sarbia M wrote the paper; all authors approved the final version of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mario Sarbia, Professor, Pathology Munich-North, Ernst-Platzstrasse 2, 80992 Munich, Germany. sarbia@pathologie-muenchen.de
Telephone: +49-89-127340 Fax: +49-89-12737474
Received: June 2, 2014
Peer-review started: June 3, 2014
First decision: August 15, 2014
Revised: September 25, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 7, 2015
Processing time: 251 Days and 23.3 Hours
Abstract

This report presents a case involving a unique observation of a high-grade squamous dysplasia involving the entire esophagus. Dysplastic cells were located exclusively in the basal portion of the esophageal squamous epithelium. The findings were documented using histologic analysis of the step-biopsies from the entire esophagus, histologic examination of the esophagectomy-specimen, immunohistochemical analysis, and molecular pathologic analysis of the p53 gene. A minimally invasive total esophagectomy was performed at the Department of Surgery of the University of Cologne, and histologic analysis of the resection specimen confirmed extensive high-grade dysplasia involving the oral resection margin, but no invasive carcinoma. This case does not fit the current World Health Organization (WHO) definition of high-grade squamous cell dysplasia, which requires full-thickness involvement of the squamous epithelium. Thus, the WHO criteria should probably be reconsidered in order to allow for a diagnosis of high-grade dysplasia in cases where dysplastic cells are exclusively located in the basal layer of the esophageal squamous epithelium.

Keywords: Basal cell compartment; Esophagus; p53-mutation; World Health Organization-classification; Squamous cell dysplasia

Core tip: An unusual case of high-grade squamous cell dysplasia involving the entire esophagus with dysplastic cells located exclusively in the basal portion of the esophageal squamous epithelium is reported. The analyses of results from step-biopsies of the entire esophagus were obtained using histologic and immunohistochemical analyses. Molecular pathologic analysis showed mutation of the p53 gene. The current World Health Organization (WHO) definition of high-grade squamous dysplasia requires full-thickness involvement of the squamous epithelium, which was not present in the current case. Therefore, we recommend that the WHO criteria should be reconsidered and revised.