eosinophilic gastroenteritis ( eg ) usually involves the stomach and small bowel , and esophageal involvement is rare .
eg is characterized by gastrointestinal symptoms , peripheral eosinophilia and eosinophil infiltration of the gastrointestinal tissues .
although all layers of the stomach and bowel may be involved , symptoms usually reflect the layer which is most severely affected .
mucosal disease may be associated with malabsorption and protein deficiency , muscle disease with obstructive symptoms and serosal disease with eosinophilic ascites .
in addition , up to 50% of patients have other manifestations of allergy and there is usually a strong family history of allergy [ 1 , 2 ] .
esophageal eosinophilia is a pathological condition defined as eosinophil infiltration within the esophageal mucosa , where eosinophils are not normally found .
this condition can have various causes , and primary or idiopathic esophageal eosinophilia is referred to as eosinophilic esophagitis ( eoe ) .
it has been reported that eoe is closely associated with allergic conditions , especially in the pediatric population .
eoe has more recently been increasingly recognized in adults and is one of the most common causes of intermittent solid food dysphagia or food impaction in western countries , but is rare in asian countries [ 5 , 6 ] .
squamous cell carcinoma ( scc ) of the esophagus is one of the most common gastrointestinal malignancies in japan and other asian countries , and it is known to be an aggressive tumor .
recent studies have indicated that eosinophil infiltration at the invasion front of esophageal scc may correlate with a less aggressive tumor [ 7 , 8 ] .
this type of eosinophil infiltration is termed tumor - associated tissue eosinophilia ( tate ) . however , the biological significance of tate as a host response to carcinoma is not necessarily consistent .
the resected esophageal wall showed eosinophil infiltration in areas not surrounding the scc , which did not appear to be pathologically consistent with eoe or tate .
a 77-year - old japanese man was admitted to our hospital for investigation and treatment of a superficial esophageal cancer , detected on upper gastrointestinal endoscopy in january 2011 . the patient had a 4-week history of decreased appetite .
endoscopic examination showed the esophageal cancer as a slightly elevated lesion , 3234 cm from the incisor teeth ( fig .
iodine staining left the tumor unstained , but showed the margin more clearly ( fig .
a biopsy of the lesion showed poorly differentiated scc without eosinophil infiltration . computed tomography revealed a normal esophagus , but found lymphadenopathy of the right cardiac nodes .
we performed an ivor lewis esophagectomy , consisting of a right thoracotomy and laparotomy with anastomosis in the chest , with two - field thoracoabdominal lymph node dissection .
the fluid collection around the anastomosis gradually drained through a drainage tube . the leakage improved over the 40 days following surgery , and the patient
the surgical specimens consisted of a 9 cm segment of esophagus with a 5 cm cuff of stomach and lymph nodes from the thoracic and upper abdominal groups . gross examination confirmed a superficial esophageal cancer measuring 2.5  2.5 cm ( fig .
there was also marked eosinophil infiltration of the full length of the esophageal wall except around the scc ( more than 100 eosinophils per high - power field ) ( fig .
eosinophil infiltration was seen in the submucosa , muscle and adventitia , but not in the mucosa ( fig .
eg is an uncommon disease characterized by peripheral eosinophilia and eosinophil infiltration of the gastrointestinal tract .
the most common sites affected are the stomach and small bowel , and esophageal involvement is rare .
the clinical presentation depends on the site of gastrointestinal tract involvement as well as the layer of the bowel wall that has been infiltrated .
eg has been classified into three types according to the predominant location of eosinophil infiltration : mucosal , muscular and subserosal .
eosinophil infiltration at the invasion front of scc is termed tate and correlates with tumor progression [ 7 , 8 ] . in our case ,
eosinophil infiltration was seen in the submucosa , muscle and adventitia of the entire esophageal wall except around the scc , and there was no peripheral eosinophilia .
pathologically , the eosinophil infiltration in this case appeared to be more similar to predominantly muscular or subserosal eg than to eoe or tate . the patient did not , however , have stenosis or obstruction as typically associated with muscular disease , or pleural effusion as typically associated with subserosal disease .
his only symptom was loss of appetite , but it is unknown whether that was related to the eosinophil infiltration or to the esophageal scc .
have previously reported a case of achalasia with esophageal eosinophilia that underwent esophageal myotomy revealing eosinophil infiltration of the muscle layer .
some reports have described that eosinophil infiltration of the muscle layers of the esophagus appeared to be related to esophageal narrowing , although no pathological diagnosis was recognized .
steroid therapy was required for severe cases of esophageal narrowing [ 11 , 12 , 13 , 14 , 15 ] .
as there was no eosinophil infiltration in the mucosa or around the scc , it would have been difficult to diagnose this by preoperative biopsy .
gross examination of the surgical specimen did not show the eosinophil infiltration , which was revealed only by microscopic examination .
if the eosinophil infiltration promoted inflammation of the esophagus , this may have been a risk factor for the leakage .
however , the significance of eosinophil infiltration in the esophageal wall remains unclear . to the best of our knowledge ,
the diagnosis was made only after esophagectomy , but eosinophil infiltration such as in this case is pathologically significant .
eosinophil infiltration of the esophagus may represent a variant of eg and may predispose to postoperative complications [ 1 , 10 ] .
 we report a case of esophageal squamous cell carcinoma ( scc ) with marked eosinophil infiltration which was identified postoperatively in the esophageal wall in areas not surrounding the scc . 
 the eosinophil infiltration was seen in the submucosa , muscle and adventitia , but not in the mucosa . 
 eosinophilic esophagitis ( eoe ) is a pathological condition defined as eosinophil infiltration within the esophageal mucosa . 
 eosinophil infiltration at the invasion front of esophageal scc is termed tumor - associated tissue eosinophilia ( tate ) 
 . however , the eosinophil infiltration in this case may be pathologically different from both eoe and tate . 
 to our knowledge , this is the first report of esophageal scc with eosinophil infiltration . 
Introduction
Case Report
Discussion
Disclosure Statement