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Extremely small but invasive esophageal cancer: endoscopists should not miss it

Published:November 30, 2021DOI:https://doi.org/10.1016/j.gie.2021.11.028
      An 81-year-old man underwent EGD screening, which revealed a depressed lesion on the posterior side of the cervical esophagus, measuring 5 mm with a marginal elevation (A). Magnified endoscopy with narrow-band imaging (ME-NBI) showed irregular vessels with disrupted loop morphology, and a thick green vessel (B). On the basis of the irregular vessel pattern, the lesion was considered squamous cell carcinoma (SCC) with submucosal invasion. We performed endoscopic submucosal dissection (C). Pathologic evaluation showed that this lesion consisted of moderately differentiated SCC, invading the submucosa to a depth of 400 μm (D). The horizontal and vertical margins were negative, but vascular invasion was present. The patient underwent additional chemoradiotherapy and has been well without recurrence.
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