We report a case of esophageal SCC in situ with histologic and microbiologic findings
of genotype 16 HPV infection successfully treated with a single session of RFA. Case report In November 2011, a 62-year-old white woman was referred to our unit because of dyspeptic syndrome. Past history included hypothyroidism treated with L-thyroxine, Irritable Bowel Syndrome and Gastroesophageal Reflux Disease managed with PPIs. Inhibitors,research,lifescience,medical Upper gastrointestinal endoscopy (UGIE) revealed the presence of a dyscromic area of about 2 cm in diameter which was located 30 cm from the incisors. Lugol staining confirmed the presence of an unstained area of about 30 mm involving half of the esophageal circumference. Histologic examination showed the presence Inhibitors,research,lifescience,medical of cytoarchitectural atypias of squamous epithelium with atypical mitosis, enlarged nuclei with nuclear alterations and parakeratotic hyperkeratosis (Figure 1). Specifically the presence of koilocytosis, giant and multinucleated cells, associated with hyperkeratosis, acanthosis, and koilocytic-like modifications suggested the possible association with an HPV Inhibitors,research,lifescience,medical infection. In March 2012 a second UGIE with multiple biopsies of the targeted
area and the entire length of esophagus was performed. Histologic diagnosis of high grade intraepithelial neoplasia (HGIEN sec. WHO) was confirmed in biopsy samples obtained from the unstained area (Figure 2). Immunohistochemical staining for CMV and HSV were negative as well as histochemical Inhibitors,research,lifescience,medical PAS staining for fungal colonization. Assessment with INNO-LiPA assay for HPV revealed positivity for genotype 16 HPV only in the biopsies obtained from the HGIEN area (Figure 3A). The same test for HPV was negative in the remaining biopsies from the rest of esophagus. In April 2012 a session of RFA (RFA; HALO90 Inhibitors,research,lifescience,medical System, GI HKI-272 datasheet Solutions, Covidien, Sunnyvale, Calif) on the dysplastic esophageal area was performed. There were no complications during or after the procedure. An UGIE with Lugol staining was repeated after
two months: a whitish semi-circumferential area suggestive of scarring was detected Mephenoxalone in the middle esophagus at the site of prior ablation, but no signs of dysplasia were evident. Microbiologic evaluation with INNO-LiPA assay excluded the persistence of HPV infection (Figure 3B). The same result was confirmed in the following UGIEs with biopsies performed in October 2012 and April 2013. Figure 1 Focal koilocytosis of squamous esophageal epithelium with nuclear abnormalities and perinuclear halos (E & E 400×). Figure 2 High grade intraepithelial neoplasia of squamous esophageal epithelium with nuclear polimorphism and mithotic figures (E & E 200×). Figure 3 INNO-LiPA HPV genotyping extra. (A) HPV 16 detected in esophageal biopsy High Grade Intraepithelial Neoplasia area; (B) HPV 16 not detected in esophageal biopsy after three months from radiofrequency ablation. HPV, human papilloma virus.