Esophageal atresia and ante-thoracic skin tube esophageal conduits: squamous cell carcinoma in the conduit 44 years following surgery.
Overview
abstract
Prior to 1941, a small group of patients born with esophageal atresia had esophageal continuity reestablished by creation of an ante-thoracic skin tube conduit. This conduit was constructed in stages using tubed bipedicle grafts of thoracic skin. William E. Ladd reported on seven such patients. M.H., a 45-year-old married female, was the first patient to undergo this procedure and had maintained a normal existence until 6 months prior to admission to this hospital in 1985. She was a nonsmoker and nondrinker who had married and borne 2 children and had maintained adequate nutrition. Six months prior to admission, the patient noticed increasing dysphagia and the presence of a firm area in the upper third of the subcutaneous esophagus. Esophagoscopy demonstrated two polypoid lesions within the conduit. Multiple biopsies did not show any evidence of malignancy. Despite this, it was felt that the subcutaneous skin tube should be removed. A substernal colonic esophageal conduit was established and the subcutaneous skin tube removed. Histologic examination revealed extensive areas of benign pseudoepitheliomatous hyperplasia with foci of well-differentiated microinvasive squamous cell carcinoma within the wall of the tube. Ultimately, excision of overlying skin, subcutaneous tissue, and muscle under the skin tube site was done. This area was covered with a skin graft. The therapeutic approach as well as the implications concerning the long-term use of skin in heterotopic locations was discussed.
