•Am J Med Su g – Oc obe 2025; 21 (2). 24-25
www.amjmedsu g.o g DOI 10.5281/zenodo.17538768
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Poo ly di e en ia ed non-ke a inizing squamous cell
ca cinoma o he esophagus. A case epo
S ephany Johana Maldonado
Rod íguez M.D.
Es ua do Emmanuel Ruiz
G amajo M.D.
Se gio Oma Ajpacajá Ga cía M.D.
Ludwing Gudiel Pé ez M.D.
José Ca los Eche e ía Solís M.D.
Ma y Geyo ana Co í Coyoy M.D.
Que zal enango, Gua emala
sophageal squamous cell ca cinoma (ESCC) is
one o he leading causes o cance - ela ed
dea hs wo ldwide. The poo ly di e en ia ed
non-ke a inizing a ian ep esen s an agg essi e
his ologic sub ype wi h limi ed ke a in o ma ion, high
mi o ic ac i i y, and nec osis. Due o nonspeci ic
symp oms, diagnosis is o en delayed un il ad anced
s ages, emphasizing he impo ance o ea ly de ec ion
and imaging co ela ion.
Case epo
A 57-yea -old man om To onicapán,
Gua emala, p esen ed wi h p og essi e dysphagia,
hea bu n, and weigh loss o e six mon hs.
Endoscopy iden i ied an ulce a ed, iable mass
obs uc ing 90% o he esophageal lumen. Biopsies
e ealed shee s o basaloid a ypical cells wi h high
nuclea - o-cy oplasmic a io and nec osis.
Immunohis ochemis y was posi i e o p40, p63, and
CK5/6, and nega i e o neu oendoc ine ma ke s,
con i ming poo ly di e en ia ed non-ke a inizing
squamous cell ca cinoma. CT scans demons a ed
ci cum e en ial wall hickening, medias inal
lymphadenopa hy, and mul iple hepa ic me as ases.
Discussion
PD-NK-SCC o he esophagus is a
mo phologically dis inc en i y lacking ke a in pea ls
and showing basaloid di e en ia ion. I ep esen s less
han 5% o esophageal SCCs bu ca ies a signi ican ly
wo se p ognosis. Immunohis ochemical s aining o
p40, p63, and CK5/6 con i ms squamous lineage,
while Ki-67 p oli e a ion index (>70%) co ela es wi h
agg essi eness. Recen molecula da a ha e iden i ied
al e a ions in he SWI/SNF ch oma in emodeling
complex (SMARCB1/SMARCA4), TP53 mu a ions,
and PD-L1 o e exp ession, which may se e as
p ognos ic bioma ke s and he apeu ic a ge s.
T ea men s a egies include su gical esec ion o
localized disease and pla inum-based
chemo adio he apy o immuno he apy o ad anced
s ages.
Conclusion
Poo ly di e en ia ed non-ke a inizing
squamous cell ca cinoma o he esophagus is a a e,
agg essi e malignancy ha equi es mul idisciplina y
managemen . Molecula p o iling and immuno he apy
ep esen p omising ad ances o imp o ing pa ien
ou comes.
Con lic s o in e es s
The au ho s ha e no con lic s o in e es s.
Acknowledgemen s
The au ho s hank he Radiology Depa men
o he Wes e n Regional Hospi al, Que zal enango,
E
Backg ound: Backg ound: Poo ly di e en ia ed non-ke a inizing squamous
cell ca cinoma (PD-NK-SCC) o he esophagus is an uncommon his ologic
sub ype cha ac e ized by basaloid mo phology, minimal ke a iniza ion, and
agg essi e beha io . Case p esen a ion: A 57-yea -old male om
To onicapán, Gua emala, p esen ed wi h p og essi e dysphagia and
e os e nal pain. Endoscopy e ealed an ulce a ed lesion obs uc ing 90% o
he esophageal lumen. His opa hology con i med PD-NK-SCC, and CT
imaging demons a ed wall hickening, medias inal lymphadenopa hy, and
hepa ic me as ases. Discussion: PD-NK-SCC exhibi s poo di e en ia ion,
high mi o ic index, and nec osis, wi h immunohis ochemical posi i i y o
p40, p63, and CK5/6. Recen genomic s udies highligh SWI/SNF complex
al e a ions (SMARCB1/SMARCA4) and PD-L1 o e exp ession as ma ke s
o agg essi eness. Conclusion: PD-NK-SCC is a a e, agg essi e malignancy
equi ing mul idisciplina y diagnosis and ea men .
Keywo ds: Non-ke a inizing squamous cell ca cinoma, esophagus,
SMARCB1, SWI/SNF, PD-L1, immuno he apy.
Radiology
Case
Repo
F om
he
Depa men o Radiology a
San Juan de Dios Wes e n Regional Hospi al, Radiology, Que zal enango, Gua emala
.
Recei ed on Oc obe
16
, 2025.
Accep ed on No embe 2, 2025. Published on No embe 5, 2025.
Maldonado Rod iguez SJ. e al. Am J Med Su g - Oc obe 2025; 21 (2). 24-25
www.amjmedsu g.o g DOI 10.5281/zenodo.17538768
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Figu e 1. Uppe and middle. Non-con as CT shows di use
esophageal wall hickening. Lowe . A e ial phase e eals i egula
mucosal enhancemen and wall dis o ion. Lowe .
Gua emala, o p o iding diagnos ic suppo and
ins i u ional collabo a ion.
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Figu e 2. Pa hology slides demons a e basaloid umo nes s wi h
cen al nec osis con i ming PD-NK-SCC.
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Se gio Oma Ajpacajá Ga cía
Depa men o Radiology
Wes e n Regional Hospi al
Que zal enango, Gua emala.
