title: Preoperative iodine staining may complicate the demarcation of esophageal carcinoma.
abstract: A 53-year-old man was suspected of having an esophageal neoplasm. An endoscopic examination including Lugol chromoendoscopy suggested an esophageal squamous cell neoplasm limited to the lamina propria. A targeted biopsy showed atypical squamous cells, and an endoscopic submucosal dissection was performed 22 days after the previous endoscopy. Although a single 40 mm unstained area was observed by preoperative Lugol chromoendoscopy, intraoperative endoscopy revealed a 25 mm iodine-unstained area, with small unstained areas scattered on the oral side. We included the small unstained areas in the extent of the resection through assessment by preoperative endoscopy. Histopathologically, the tumor extent appeared to coincide with the preoperative assessment. Tumor cells were found in the basal-parabasal layers of the mucosa, in which small unstained areas were scattered, although the superficial layers exhibited well-differentiated cells containing glycogen in the cytoplasm. Although Lugol chromoendoscopy, which can induce chemical esophagitis, is widely used, re-epithelialization after mucosal damage by preoperative iodine staining may complicate the intraoperative demarcation of tumors.
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Itsuko
authors.initials: I
authors.lastname: Asada-Hirayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Shinya
authors.initials: S
authors.lastname: Kodashima
authors.forename: Keiko
authors.initials: K
authors.lastname: Niimi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mochizuki
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Keisuke
authors.initials: K
authors.lastname: Matsusaka
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
keywords: Esophageal squamous cell neoplasm; Lugol chromoendoscopy; Re-epithelialization
references.citation: Gastrointest Endosc. 2004 Jun;59(7):925-6
references.pmid: 15173818
references.citation: Gastrointest Endosc. 2001 Jan;53(1):1-5
references.pmid: 11154480
references.citation: Dis Esophagus. 2011 Aug;24(6):418-22
references.pmid: 21309914
references.citation: World J Gastrointest Endosc. 2012 May 16;4(5):162-6
references.pmid: 22624067
references.citation: Cancer. 1990 Nov 15;66(10):2068-71
references.pmid: 1699649
references.citation: Dig Endosc. 2011 May;23 Suppl 1:58-71
references.pmid: 21535204
references.citation: Clin Gastroenterol Hepatol. 2006 Jun;4(6):688-94
references.pmid: 16713746
references.citation: Gastrointest Endosc. 2001 Feb;53(2):199-202
references.pmid: 11174292
references.citation: Endoscopy. 2010 Aug;42(8):613-9
references.pmid: 20669074
references.citation: J Clin Oncol. 2010 Mar 20;28(9):1566-72
references.pmid: 20177025
references.citation: Endoscopy. 2002 May;34(5):369-75
references.pmid: 11972267
references.citation: Scand J Gastroenterol. 2007 Jan;42(1):135-7
references.pmid: 17190773
references.citation: Cancer. 1998 Jul 15;83(2):220-31
references.pmid: 9669803
references.citation: Gut. 2005 Jun;54(6):886-7
references.pmid: 15888800
references.citation: World J Gastroenterol. 2010 Mar 7;16(9):1043-9
references.pmid: 20205272
references.citation: World J Gastroenterol. 2011 Oct 21;17(39):4408-13
references.pmid: 22110267