A rare case of primary esophageal Paget’s disease with underlying invasive adenocarcinoma

A rare case of primary esophageal Paget's disease with underlying invasive adenocarcinoma A 53-year-old man presented to Ruijin Hospital, having been followed up for 9 months with an esophageal lesion that had initially been detected during a routine esophagogastroduodenoscopy (EGD) and had been diagnosed histopathologically as a high grade intraepithelial neoplasia (HGIN).The inpatient EGD revealed a flat (0-IIb) and slightly reddish lesion spanning from 25 to 38 cm of the middle-to-lower esophagus ( Fig. 1).Magnifying endoscopy with blue-laser imaging (ME-BLI) identified an intrapapillary capillary loop (IPCL) pattern consistent with type B1 ( Fig. 1 d-f).Notably, a 5 5-mm slightly elevated area with mild congestion was observed within the lesion at 26 cm ( Fig. 1 a).The lesion remained unstained after the application of Lugols solution and exhibited a partial pink-color sign from 30 to 33 cm of the esophagus, without any signs of deep invasion ( Fig. 1 g-i).Pathology and immunohis- Fig. 1 Endoscopic features of the lesion before radiofrequency ablation on: a-c white-light endoscopy; d-f magnifying endoscopy with blue-laser imaging; g-i after staining with Lugol's solution. Fig. 2 Microscopic appearance of the of biopsy specimen on: a, b hematoxylin and eosin (H&E) staining; c-l immunohistochemical staining with: c CK7(+); d CK19(+); e P53(missense mutation); f P63(little+); g P40(little+); h CK20(-); i Ki67(70%+); j AE1/AE3(+); k CK5/6(partial+); l P16(-).