Lymphoepithelioma-like esophageal carcinoma with macroscopic reduction

Figure 1 The endoscopic findings. A: The first endoscopy (at the previous clinic) showed a submucosal-like tumor of approximately 10 mm in diameter. The lesion, except for the erosion at the top, was stained with Lugol’s solution; B: The second endoscopy (performed two weeks after the first endoscopy) showed a raised tumor with a central dip. The height of the tumor had decreased; C: The third endoscopy (performed during the endoscopic operation, two months after the first endoscopy) showed that the tumor had become flattened, similar to a scar (arrowhead).

Figure 2 The endoscopically-biopsied material. A: The inflammatory cell infiltration in the mucosa was remarkable (HE staining, original magnification × 40); B: Squamous cell carcinoma with prominent infiltration of lymphoid cells was revealed (HE staining, original magnification × 100).

Figure 3 The endoscopically-resected material. A: The gross appearance of the resected esophageal mucosa is shown. There was a superficial smooth tumor measuring 6 mm × 3 mm in the resected mucosa (line), and it was difficult to find the tumor macroscopically; B: The tumor, with prominent lymphoid cell infiltration, was mainly visible in the submucosal layer (HE staining, original magnification × 10). The vertical margin was positive (arrow).

Figure 4 The histopathological findings. A: Poorly differentiated squamous cells and lymphocytes that had infiltrated into the carcinoma cell nests were observed (HE staining, original magnification × 400); B: Prominent infiltration of cytotoxic T lymphoid cells that stained positive for CD8 was observed between and around the carcinoma cells (× 400); C: Strong expression of human leukocyte antigen-DR was evident in the cell membrane in nearly all carcinoma cells and in the lymphocytes around the tumor (× 400).

Figure 5 The surgically dissected lymph node from the neck area. A: In the lymph node, which was 5 mm in diameter, a metastasis that was 2 mm in diameter was found (HE staining, original magnification × 40); B: Histological evaluation showed that lymphocytes had infiltrated around the carcinoma cells (HE staining, original magnification × 200). Many denatured carcinoma cells, which had karyorrhexis, an indistinct cell membrane, or karyotheca in the lymph node, were observed (arrow). Many viable carcinoma cells were observed (arrowhead).