title: Endoscopic submucosal dissection for an atypical small verrucous carcinoma: a case report.
abstract: BACKGROUND
  Esophageal verrucous carcinoma is a rare variant of esophageal squamous cell carcinoma. In most cases, verrucous carcinoma presents as an exophytic, slow-growing mass with an extensive superficial growth pattern. Symptoms often include an insidious onset of dysphagia resulting in weight loss. In a patient presenting with super early-stage verrucous carcinoma, we were able to eliminate the aberration using endoscopic submucosal dissection.
  
  
  METHODS
  An asymptomatic 68-year-old Asian man was found to have an abnormality in his esophagus. The abnormality was discovered, by chance, in a barium study for a health checkup. Esophagogastroduodenoscopy revealed a 1-centimeter polypoid lesion covered with squamous epithelium. Biopsies showed squamous high-grade intraepithelial neoplasia. An endoscopic submucosal dissection was performed and the histopathological findings showed a well-differentiated squamous cell carcinoma with hyperkeratosis with a church spire configuration. These features are consistent with the growth pattern of verrucous carcinoma.
  
  
  CONCLUSIONS
  Verrucous carcinoma can manifest as a small mass with nonclinical symptoms and endoscopic submucosal dissection is useful as a curative treatment. We must consider that verrucous carcinoma can manifest as appearance of a polyp that is not papillary or warty-like with and without extensive superficial growth appearance.
authors.affiliation: Department of Endoscopy, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Endoscopy, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan. masakato89@gmail.com.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology and Hepatology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Munenori
authors.initials: M
authors.lastname: Itagaki
authors.affiliation: Department of Pathology, Clinical Service, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Sigeharu
authors.initials: S
authors.lastname: Hamatani
authors.affiliation: Department of Endoscopy, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kawahara
authors.affiliation: Department of Endoscopy, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology and Hepatology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Aizawa
authors.affiliation: Department of Endoscopy, The Jikei University Katsushika Medical Center, 6-41-2 Aoto Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D018289:Carcinoma, Verrucous / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection; D004938:Esophageal Neoplasms / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D006801:Humans; D033162:Incidental Findings; D008297:Male
keywords: Endoscopic submucosal dissection; Esophagus; Verrucous carcinoma