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Canadian Journal of Gastroenterology
Volume 18, Issue 7, Pages 459-462
Brief Communication

Verrucous Carcinoma of the Esophagus Eluding Multiple Sets of Endoscopic Biopsies and Endoscopic Ultrasound: A Case Report and Review of the Literarure

Shane Devlin,1 Vincent Falck,2 Stefan J Urbanski,2 Philip Mitchell,3 and Joseph Romagnuolo1,4

1Division of Gastroenterology, The University of Calgary, Calgary, Alberta, Canada
2Department of Pathology, The University of Calgary, Calgary, Alberta, Canada
3Department of Surgery, The University of Calgary, Calgary, Alberta, Canada
4Department of Community Health Sciences, The University of Calgary, Calgary, Alberta, Canada

Received 26 February 2004; Accepted 21 April 2004

Copyright © 2004 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 56-year-old woman was noted to have a 5 cm to 6 cm long, irregular narrowing of the distal esophagus on an upper gastrointestinal series. Initial endoscopy revealed a polypoid mass in the distal esophagus and concurrent endoscopic ultrasound revealed changes typical of inflammation but no evidence of an obvious neoplastic process. Repeated biopsies revealed only inflammation with no evidence of malignancy. Only after prolonged acid suppression did biopsies reveal verrucous carcinoma of the esophagus. The patient underwent a trans-hiatal esophagectomy and has remained well with no evidence of progression since. Verrucous carcinoma is a rare variant of squamous cell carcinoma, taking on a papillary or warty appearance grossly. Histological diagnosis may be difficult because this tumour typically shows no high-grade dysplasia. Therefore, diagnosis can be challenging, often requiring multiple sets of endoscopic biopsies due to the overlying hyperkeratotic layer. Of the 20 cases that have been reported, this is the second to provide an endosonographic description and the first to describe a change in endoscopic appearance with acid suppression.