Introduction: Verrucous carcinomas are a slow-growing variant of squamous cell carcinoma that can rarely be seen in the esophagus. Risk factors are thought to be chronic mucosal irritation, tobacco use, alcohol use, achalasia, and human papilloma virus. The disease can go undiagnosed as superficial biopsies are nonspecific and often deep mucosal biopsies are needed to make a true diagnosis. Here we have a case of a patient that had slow-growing verrucous carcinoma that took three upper endoscopies with biopsies to finally make the diagnosis.
Case Description/Methods: This is a case of an 81-year-old man who presented to clinic with a history of progressive dysphagia. He had a history of candida esophagitis and strictures for which he had been dilated in the past. He underwent repeat upper endoscopy that revealed esophageal mucosa with fungating lesions and white exudate. Due to a recent history of progressive dysphagia with weight loss, jumbo forceps and bite-on-bite biopsies were taken for deeper examination. The biopsies revealed verrucous carcinoma. He underwent imaging and paratracheal lymph node biopsy that also returned positive for squamous cell carcinoma. He underwent chemotherapy and radiation with great improvement in his symptoms.
Discussion: Verrucous carcinoma is a rare form of slow-growing squamous cell carcinoma that is rarely seen in the esophagus, and when it is, can spread locally. It is often treated with either surgery or chemo-radiation. It is important to recall this diagnosis as it can be difficult to diagnose on superficial biopsies but rather takes clinical suspicion based on endoscopic findings to recognize and evaluate with deeper mucosal biopsies or endoscopic ultrasonography with biopsy. Oftentimes, patients will require percutaneous gastrostomy tubes placed for feedings while they undergo therapy for the verrucous carcinoma.
