Pagetoid Squamous Cell Carcinoma In-Situ of Esophagus

Squamous cell carcinoma (SCC) is the most common malignant tumor of the esophagus, however, pagetoid SCCIS is an extremely rare condition in esophagus.1 Pagetoid Squamous Cell Carcinoma In-Situ (SCCIS) has been described in skin and external genitalia frequently.2 Herein we report a case of pagetoid squamous cell carcinoma in-situ in a 50-year-old male with clinical information, histopathological and immunohistochemical findings. The patient was a 50 years male with dyspepsia,refractory to proton pump inhibitors (PPIs). In upper gastroduodenal endoscopy, there was no obvious lesion in the esophagus and only mild erythema was noted. Biopsy showed a surprising finding of full thickness high grade squamous dysplasia in the lining squamous epithelium with scattered single large atypical cells. These cells were present away from the foci of dysplasia. The cells were large and showed marked pleomorphism, vesicular nuclei, prominent nucleoli and abundant pale to eosinophilic cytoplasm. Immunohistochemistry (IHC) was positive for p63 and p53, which confirmed the diagnosis of pagetoid SCCIS. Pagetoid squamous cell carcinoma in-situ is one of the rare entities with subtle clinical presentation and endoscopic findings. Evaluation of this case signifies the importance of taking biopsies in the lesions which shows minimal mucosal change in the endoscopy.