Diagnosis and treatment of three synchronous early squamous cell carcinomas of the esophagus: case report

Objective. To present a clinical case of endoscopic diagnosis and radical treatment using submucosal dissection for three synchronous early squamous malignant neoplasms of the esophagus. Case report. A 63-year-old patient undergoing routine video esophagogastroduodenoscopy was found to have three non-polypoid epithelial lesions located in the upper, middle, and lower thirds of the esophagus. The largest lesion measured approximately 3 cm and occupied two-thirds of the esophageal circumference. Histological analysis revealed high-grade intraepithelial neoplasia. A chest and abdominal computed tomography scan showed no evidence of regional or distant metastases. Based on a multidisciplinary oncology team decision, endoscopic removal was performed in two stages. Submucosal dissection was used to excise all three lesions as a single block, with histopathological analysis confirming squamous cell carcinoma limited to the lamina propria of the mucosa (T1a m2), alongside areas of high- and low-grade dysplasia, without angiolymphatic invasion (LVI -) and with negative resection margins (R0). The patient was diagnosed with synchronous esophageal cancer, staged as T1aN0M0. Follow-up endoscopy revealed postoperative scarring without luminal narrowing. The patient was referred for dynamic follow-up with an oncologist at their local facility. Conclusion. This is the first reported case of three synchronous early squamous neoplasms of the esophagus, diagnosed by esophagogastroduodenoscopy and treated with radical endoscopic submucosal dissection.