title: Aortic squamous metaplasia in a patient with aortoesophageal fistula secondary to thoracic aortic aneurysm: an autopsy case.
abstract: Aortoesophageal fistula (AEF) is highly lethal. A 74-year-old man presented with hematemesis and consciousness loss. He had a long-term history of hypertension and gout. Computed tomography revealed an aneurysm of the distal descending thoracic aorta, which was treated by insertion of an aortic stent graft. After 24 days of stenting, endoscopic examination revealed an AEF. After 6 months of stenting, he died owing to mediastinitis. On autopsy, macroscopically, we found a 4 × 2.5-cm, oval, well-circumscribed AEF. We identified squamous epithelium in the area surrounding the AEF that covered the thoracic aorta inner cavity. Immunohistochemical analysis revealed that the squamous epithelium in the thoracic aorta was positive for p63 and 34βE12. In conclusion, we encountered a long-term AEF case with aortic squamous metaplasia. To the best of our knowledge, human aortic metaplasia has never been reported. In the present case, aortic squamous metaplasia retained continuity with the esophageal squamous epithelium; therefore, the migration of the squamous epithelium through the AEF may have been induced by aortic erosion.
authors.affiliation: Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan; Departments of Pathology and Integrative Oncological Pathology, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Yuh
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honma
authors.forename: Ryuji
authors.initials: R
authors.lastname: Ohashi
authors.forename: Zenya
authors.initials: Z
authors.lastname: Naito
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishiwata
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000473:pathology*; D001344:Autopsy; D004937:Esophageal Fistula / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000175:diagnosis / Q000473:pathology*; D015607:Stents
keywords: aortoesophageal fistula; autopsy; squamous metaplasia; thoracic aortic aneurysm