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Superficial Esophageal Neoplasms Overlying Leiomyomas Removed by Endoscopic Submucosal Dissection: Case Reports and Review of the Literature.

Seo M, Kim do H, Cho YW, Gong EJ, Lee S, Choi E, Jung HY, Kim JH - Clin Endosc (2015)

Bottom Line: The coexistence of an epithelial lesion and a subepithelial lesion is uncommon.In almost all such cases, the coexistence of these lesions appears to be incidental.Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The coexistence of an epithelial lesion and a subepithelial lesion is uncommon. In almost all such cases, the coexistence of these lesions appears to be incidental. It is also extremely rare to encounter a neoplasm in the surface epithelium that overlies a benign mesenchymal tumor in the esophagus. Several cases of a coexisting esophageal neoplasm overlying a leiomyoma that is treated endoscopically or surgically have been reported previously. Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.

No MeSH data available.


Related in: MedlinePlus

(A) An endoscopic image shows a subepithelial tumor with an eroded surface in the middle third of the esophagus. (B) Lugol chromoendoscopy shows the iodine-unstained lesion. (C) Endoscopic ultrasonography demonstrates a hypoechoic, homogeneous lesion that originates from the muscularis mucosa and is covered by a squamous cell carcinoma in situ. (D) The specimen with the lesion after its en bloc resection.
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Figure 1: (A) An endoscopic image shows a subepithelial tumor with an eroded surface in the middle third of the esophagus. (B) Lugol chromoendoscopy shows the iodine-unstained lesion. (C) Endoscopic ultrasonography demonstrates a hypoechoic, homogeneous lesion that originates from the muscularis mucosa and is covered by a squamous cell carcinoma in situ. (D) The specimen with the lesion after its en bloc resection.

Mentions: A 66-year-old man was referred to our hospital for the treatment of an epithelial lesion with severe dysplasia, which was histologically confirmed at a local primary care clinic. Five years previously, he had undergone esophagogastroduodenoscopy (EGD) during a health checkup, and an esophageal subepithelial tumor (SET) was diagnosed during the examination. However, the patient did not return for follow-up of the lesion. The EGD showed a protruding mass that measured 1×1 cm in diameter and was located 25 cm from the upper incisors. The surface mucosa of the lesion was slightly irregular and did not stain with Lugol's solution. Endoscopic ultrasonography (EUS) demonstrated a hypoechoic and homogeneous lesion that originated from the muscularis mucosa (MM) below the epithelial layer. Endoscopic biopsy confirmed that the esophageal lesion was an SCC. EUS and chest computed tomography showed no evidence of lymph node metastasis in the mediastinum. The patient was diagnosed with SCC overlying a leiomyoma from the MM. En bloc resection using ESD was chosen as a curative treatment (Fig. 1). Histopathological examination of the resected lesion revealed an esophageal leiomyoma that underlay the SCC in situ and was 20×11 mm in size, and the leiomyoma consisted of bland spindle cells with cigar-shaped nuclei. The atypical squamous cells were confined to the mucosa, and both the lateral and vertical resection margins were tumor-free. Immunohistochemical staining showed Ki-67-positive atypical squamous cells in the entire layer. The leiomyoma demonstrated diffuse positive staining for smooth muscle actin (Fig. 2). The patient was followed up with annual EGD after the ESD. There was no local recurrence over the following 46 months.


Superficial Esophageal Neoplasms Overlying Leiomyomas Removed by Endoscopic Submucosal Dissection: Case Reports and Review of the Literature.

Seo M, Kim do H, Cho YW, Gong EJ, Lee S, Choi E, Jung HY, Kim JH - Clin Endosc (2015)

(A) An endoscopic image shows a subepithelial tumor with an eroded surface in the middle third of the esophagus. (B) Lugol chromoendoscopy shows the iodine-unstained lesion. (C) Endoscopic ultrasonography demonstrates a hypoechoic, homogeneous lesion that originates from the muscularis mucosa and is covered by a squamous cell carcinoma in situ. (D) The specimen with the lesion after its en bloc resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522425&req=5

Figure 1: (A) An endoscopic image shows a subepithelial tumor with an eroded surface in the middle third of the esophagus. (B) Lugol chromoendoscopy shows the iodine-unstained lesion. (C) Endoscopic ultrasonography demonstrates a hypoechoic, homogeneous lesion that originates from the muscularis mucosa and is covered by a squamous cell carcinoma in situ. (D) The specimen with the lesion after its en bloc resection.
Mentions: A 66-year-old man was referred to our hospital for the treatment of an epithelial lesion with severe dysplasia, which was histologically confirmed at a local primary care clinic. Five years previously, he had undergone esophagogastroduodenoscopy (EGD) during a health checkup, and an esophageal subepithelial tumor (SET) was diagnosed during the examination. However, the patient did not return for follow-up of the lesion. The EGD showed a protruding mass that measured 1×1 cm in diameter and was located 25 cm from the upper incisors. The surface mucosa of the lesion was slightly irregular and did not stain with Lugol's solution. Endoscopic ultrasonography (EUS) demonstrated a hypoechoic and homogeneous lesion that originated from the muscularis mucosa (MM) below the epithelial layer. Endoscopic biopsy confirmed that the esophageal lesion was an SCC. EUS and chest computed tomography showed no evidence of lymph node metastasis in the mediastinum. The patient was diagnosed with SCC overlying a leiomyoma from the MM. En bloc resection using ESD was chosen as a curative treatment (Fig. 1). Histopathological examination of the resected lesion revealed an esophageal leiomyoma that underlay the SCC in situ and was 20×11 mm in size, and the leiomyoma consisted of bland spindle cells with cigar-shaped nuclei. The atypical squamous cells were confined to the mucosa, and both the lateral and vertical resection margins were tumor-free. Immunohistochemical staining showed Ki-67-positive atypical squamous cells in the entire layer. The leiomyoma demonstrated diffuse positive staining for smooth muscle actin (Fig. 2). The patient was followed up with annual EGD after the ESD. There was no local recurrence over the following 46 months.

Bottom Line: The coexistence of an epithelial lesion and a subepithelial lesion is uncommon.In almost all such cases, the coexistence of these lesions appears to be incidental.Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The coexistence of an epithelial lesion and a subepithelial lesion is uncommon. In almost all such cases, the coexistence of these lesions appears to be incidental. It is also extremely rare to encounter a neoplasm in the surface epithelium that overlies a benign mesenchymal tumor in the esophagus. Several cases of a coexisting esophageal neoplasm overlying a leiomyoma that is treated endoscopically or surgically have been reported previously. Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.

No MeSH data available.


Related in: MedlinePlus