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Polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection
Author(s) -
Yamamoto Yoshinobu,
Nishisaki Hogara,
Koma Yuichiro,
Sawai Hiroaki,
Sakai Aya,
Mimura Takuya,
Kushida Saeko,
Tsumura Hidetaka,
Sakamoto Takeshi,
Tobimatsu Kazutoshi,
Miki Ikuya,
Sakuma Toshiko,
Tsuda Masahiro,
Mano Masayuki,
Hirose Takanori,
Inokuchi Hideto
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12437
Subject(s) - medicine , esophagus , muscularis mucosae , leiomyosarcoma , pathology , submucosa , biopsy , lumen (anatomy) , dysphagia , radiology , anatomy , surgery
We report a rare case of polypoid leiomyosarcoma of the esophagus that was treated by endoscopic submucosal dissection ( ESD ). A 63‐year‐old man with complaints of progressive dysphagia was referred to Hyogo Cancer Center for treatment of esophageal tumor. Esophagoscopy revealed a polypoid tumor 25 mm in diameter on the left side of the upper esophagus. Despite several biopsy specimens, the diagnosis could not be confirmed. Computed tomography showed a protruded, homogeneously enhancing mass in the upper esophagus, but no lymph node enlargement or metastasis. After 1.5 months, the esophagogram showed a filling defect 47 mm in diameter in the upper esophagus. Given this rapid tumor growth, en bloc resection was done by ESD for therapeutic diagnosis. After this treatment, the tumor seemed to grow larger, showing a short stalk and occupying the esophageal lumen. Histopathologically, the tumor comprised pleomorphic spindle cells with mitosis. Tumor invasion involved the lumina propria mucosae and contact with the muscularis mucosae, but not involving the submucosa. Immunohistochemical examination showed positive staining for smooth muscle actin and HHF35 , but negative for desmin, caldesmon, CD34 , c‐kit, DOG1 , ALK , S ‐100 protein and cytokeratin. These histopathological findings were compatible with a diagnosis of esophageal leiomyosarcoma derived from the muscularis mucosae.