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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) Histological mapping of the resected specimen shows severe dysplasia with a leiomyoma. The black lines indicate the cutting line of the block sections. The yellow circle corresponds to the leiomyoma and the red squares correspond to atypical squamous cells. The lateral margin is positive in section 2 (arrow). (B) There are two sections: section 1 is composed of leiomyoma and severe squamous cell dysplasia on the lateral portion (red arrow), and section 2 shows the positive lateral margin (H&E stain, ×12.5). (C) The positive margin can be seen when the black circle in Fig. 5B is magnified (H&E stain, ×100). (D) The specimen with the lesion is histologically diagnosed after resection as high-grade intraepithelial squamous neoplasia (H&E stain, ×40). (E) The esophageal leiomyoma is strongly and diffusely positive for smooth muscle actin (×40). (F) The esophageal leiomyoma is positive for desmin (×40).
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Figure 4: (A) Histological mapping of the resected specimen shows severe dysplasia with a leiomyoma. The black lines indicate the cutting line of the block sections. The yellow circle corresponds to the leiomyoma and the red squares correspond to atypical squamous cells. The lateral margin is positive in section 2 (arrow). (B) There are two sections: section 1 is composed of leiomyoma and severe squamous cell dysplasia on the lateral portion (red arrow), and section 2 shows the positive lateral margin (H&E stain, ×12.5). (C) The positive margin can be seen when the black circle in Fig. 5B is magnified (H&E stain, ×100). (D) The specimen with the lesion is histologically diagnosed after resection as high-grade intraepithelial squamous neoplasia (H&E stain, ×40). (E) The esophageal leiomyoma is strongly and diffusely positive for smooth muscle actin (×40). (F) The esophageal leiomyoma is positive for desmin (×40).

Mentions: A 74-year-old man was admitted for treatment of a histologically proven esophageal SCC. EGD revealed a 1 cm-sized elevated lesion with a smooth surface that was located in the proximal third of the esophagus. After the lesion was sprayed with Lugol's solution, ill-demarcated and unstained areas could be observed overlying the lesion. EUS demonstrated a hypoechoic tumor that was 5.6×2.9 mm in size and that originated from the MM. The patient was diagnosed with SCC overlying a leiomyoma from the MM. ESD was performed under general anesthesia. En bloc resection of the lesion was performed. There was no lymphovascular invasion or involvement of the deep resection margin, but there was involvement of the lateral resection margin in one block section. Histopathological examination of the resected lesion revealed high-grade dysplasia that overlay a leiomyoma (Fig. 3). The leiomyoma was positive for smooth muscle actin and desmin and its greatest dimension was 1.3 cm (Fig. 4). Follow-up endoscopy was selected rather than additional surgical resection because the apparent involvement of the lateral resection margin could have been a false positive due to a cautery effect. The patient underwent endoscopic examination after 8 months. Local recurrence was not observed; therefore, no biopsy was performed. The patient was also followed up with annual EGD and to date, the patient has remained disease-free for 28 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) Histological mapping of the resected specimen shows severe dysplasia with a leiomyoma. The black lines indicate the cutting line of the block sections. The yellow circle corresponds to the leiomyoma and the red squares correspond to atypical squamous cells. The lateral margin is positive in section 2 (arrow). (B) There are two sections: section 1 is composed of leiomyoma and severe squamous cell dysplasia on the lateral portion (red arrow), and section 2 shows the positive lateral margin (H&E stain, ×12.5). (C) The positive margin can be seen when the black circle in Fig. 5B is magnified (H&E stain, ×100). (D) The specimen with the lesion is histologically diagnosed after resection as high-grade intraepithelial squamous neoplasia (H&E stain, ×40). (E) The esophageal leiomyoma is strongly and diffusely positive for smooth muscle actin (×40). (F) The esophageal leiomyoma is positive for desmin (×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: (A) Histological mapping of the resected specimen shows severe dysplasia with a leiomyoma. The black lines indicate the cutting line of the block sections. The yellow circle corresponds to the leiomyoma and the red squares correspond to atypical squamous cells. The lateral margin is positive in section 2 (arrow). (B) There are two sections: section 1 is composed of leiomyoma and severe squamous cell dysplasia on the lateral portion (red arrow), and section 2 shows the positive lateral margin (H&E stain, ×12.5). (C) The positive margin can be seen when the black circle in Fig. 5B is magnified (H&E stain, ×100). (D) The specimen with the lesion is histologically diagnosed after resection as high-grade intraepithelial squamous neoplasia (H&E stain, ×40). (E) The esophageal leiomyoma is strongly and diffusely positive for smooth muscle actin (×40). (F) The esophageal leiomyoma is positive for desmin (×40).
Mentions: A 74-year-old man was admitted for treatment of a histologically proven esophageal SCC. EGD revealed a 1 cm-sized elevated lesion with a smooth surface that was located in the proximal third of the esophagus. After the lesion was sprayed with Lugol's solution, ill-demarcated and unstained areas could be observed overlying the lesion. EUS demonstrated a hypoechoic tumor that was 5.6×2.9 mm in size and that originated from the MM. The patient was diagnosed with SCC overlying a leiomyoma from the MM. ESD was performed under general anesthesia. En bloc resection of the lesion was performed. There was no lymphovascular invasion or involvement of the deep resection margin, but there was involvement of the lateral resection margin in one block section. Histopathological examination of the resected lesion revealed high-grade dysplasia that overlay a leiomyoma (Fig. 3). The leiomyoma was positive for smooth muscle actin and desmin and its greatest dimension was 1.3 cm (Fig. 4). Follow-up endoscopy was selected rather than additional surgical resection because the apparent involvement of the lateral resection margin could have been a false positive due to a cautery effect. The patient underwent endoscopic examination after 8 months. Local recurrence was not observed; therefore, no biopsy was performed. The patient was also followed up with annual EGD and to date, the patient has remained disease-free for 28 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