Digestive Endoscopy 2015; 27: 700–703
doi: 10.1111/den.12437
Case Report
Polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection Yoshinobu Yamamoto,1 Hogara Nishisaki,3 Yu-ichiro Koma,4 Hiroaki Sawai,1 Aya Sakai,1 Takuya Mimura,1 Saeko Kushida,1 Hidetaka Tsumura,1 Takeshi Sakamoto,1 Kazutoshi Tobimatsu,1 Ikuya Miki,1 Toshiko Sakuma,2 Masahiro Tsuda,1 Masayuki Mano,5 Takanori Hirose2 and Hideto Inokuchi1 Departments of 1Gastroenterology and 2Diagnostic Pathology, Hyogo Cancer Center, 3Department of Internal Medicine, Kaibara Hospital, 4Department of Pathology, Kobe University Graduate School of Medicine, Hyogo, and 5Department of Clinical Laboratory, Osaka Medical Center, Osaka, Japan
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
INTRODUCTION
L
EIOMYOSARCOMAS OF THE esophagus are rare malignancies accounting for 0.1–0.5% of all malignant esophageal tumors.1 Leiomyosarcomas usually show slow growth and late metastasis, and carry a good prognosis.2 Treatment mostly involves surgical excision,3,4 so few cases with endoscopic resection have been described.5 Herein, we report a case of polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection (ESD), representing the first report of ESD to treat this disease.
CASE REPORT
A
63-YEAR-OLD MAN WITH a 1-month history of progressive dysphagia was referred to Hyogo Cancer
Corresponding: Yoshinobu Yamamoto, Department of Gastroenterology, Hyogo Cancer Center, Kitaoji 13-70, Akashi, Hyogo 6738558, Japan. Email: [email protected] Received 26 November 2014; accepted 14 January 2015.
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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. Key words: dissection, endoscopic, esophagus, leiomyosarcoma, submucosal
Center for treatment of esophageal tumor. The patient’s medical history was unremarkable. He was a heavy smoker and had a habit of drinking alcohol every day. Physical examination revealed no abnormalities. Laboratory and urological data were within normal range, including carbohydrate antigen 19-9 (CA19-9) and squamous cell carcinoma antigen (SCC), with the exception of slightly increased carcinoembryonic antigen (CEA) (9.1 ng/mL, normal range
doi: 10.1111/den.12437
Case Report
Polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection Yoshinobu Yamamoto,1 Hogara Nishisaki,3 Yu-ichiro Koma,4 Hiroaki Sawai,1 Aya Sakai,1 Takuya Mimura,1 Saeko Kushida,1 Hidetaka Tsumura,1 Takeshi Sakamoto,1 Kazutoshi Tobimatsu,1 Ikuya Miki,1 Toshiko Sakuma,2 Masahiro Tsuda,1 Masayuki Mano,5 Takanori Hirose2 and Hideto Inokuchi1 Departments of 1Gastroenterology and 2Diagnostic Pathology, Hyogo Cancer Center, 3Department of Internal Medicine, Kaibara Hospital, 4Department of Pathology, Kobe University Graduate School of Medicine, Hyogo, and 5Department of Clinical Laboratory, Osaka Medical Center, Osaka, Japan
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
INTRODUCTION
L
EIOMYOSARCOMAS OF THE esophagus are rare malignancies accounting for 0.1–0.5% of all malignant esophageal tumors.1 Leiomyosarcomas usually show slow growth and late metastasis, and carry a good prognosis.2 Treatment mostly involves surgical excision,3,4 so few cases with endoscopic resection have been described.5 Herein, we report a case of polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection (ESD), representing the first report of ESD to treat this disease.
CASE REPORT
A
63-YEAR-OLD MAN WITH a 1-month history of progressive dysphagia was referred to Hyogo Cancer
Corresponding: Yoshinobu Yamamoto, Department of Gastroenterology, Hyogo Cancer Center, Kitaoji 13-70, Akashi, Hyogo 6738558, Japan. Email: [email protected] Received 26 November 2014; accepted 14 January 2015.
bs_bs_banner
700
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. Key words: dissection, endoscopic, esophagus, leiomyosarcoma, submucosal
Center for treatment of esophageal tumor. The patient’s medical history was unremarkable. He was a heavy smoker and had a habit of drinking alcohol every day. Physical examination revealed no abnormalities. Laboratory and urological data were within normal range, including carbohydrate antigen 19-9 (CA19-9) and squamous cell carcinoma antigen (SCC), with the exception of slightly increased carcinoembryonic antigen (CEA) (9.1 ng/mL, normal range
