Endoscopic palliative resection of a giant 26-cm esophageal tumor: A case report

Abstract

BACKGROUND Esophageal carcinosarcoma, usually presenting as a pedunculated polypoid mass, is a rare malignancy with coexisting sarcomatoid and carcinomatous components. Its imaging and endoscopic characteristics are similar to those of leiomyosarcoma, liposarcoma and so forth. The diagnosis needs histological confirmation. Surgical resection is the traditional therapy. Endoscopic resection is minimally invasive but still controversial. This paper reports the case of a patient with a giant esophageal carsinosarcoma who underwent a palliative endoscopic resection. CASE SUMMARY A 55-year-old male patient presented with dysphagia and weight loss for 1 mo. Imaging and endoscopy showed a gray-white, polypoid, stalk-like mass, with a bulky pedicle located in the middle and lower esophagus. The mass almost filled the whole esophageal lumen, but the endoscope could still pass through. Despite the suspicion of a malignancy, repeated biopsies indicated necrosis and inflammation. After multidisciplinary team consultation, an endoscopic resection to diagnose and relieve the obstruction was recommended. The pedicle of the mass was cut off, the bleeding was stopped, and the mass was cut into pieces and pulled out. The mass was 26 cm × 5 cm × 4 cm in size. The final diagnosis was esophageal carcinosarcoma. No postoperative complications occurred. After 1 mo, the patient gained 6 kg and endoscopic reexamination revealed no obstruction. Radical surgery with lymph node dissection was carried out successfully. This lesion was the largest endoscopically resected esophageal carcinosarcoma reported to date. CONCLUSION Endoscopic palliative resection can help obtain adequate tissue for diagnosis and relieve obstructions in patients with giant esophageal carcinosarcoma.

Esophageal Carcinosarcoma: Analysis of Clinical Features and Prognosis of 24 Cases and a Literature Review

“…The tumor was the largest endoscopically resected ECS reported to date. 36 Radiotherapy is also an option for patients who can not tolerate surgery. Kimura et al reported that palliative radiotherapy alone (45 Gy /15 FR) could achieve complete pathological response in an 89 year old patient with a tumor diameter (T 2 N 0 M 0 ) of 80 mm.…”

A giant esophageal liposarcoma radically resected by the cervical approach: a case report

“…Because positive margins are closely associated with a high risk of local recurrence, extensive resection may be recommended depending on the histology and site of origin. In general, liposarcoma does not develop lymph node metastasis or distant metastasis, and some cases of esophageal liposarcoma of luminal growth type were reported to have been resected orally or transendoscopically [4,15]. According to the literature reports of 67 cases of esophageal liposarcoma, 34.3% of patients underwent esophagotomy, 22.4% of patients underwent esophagectomy, 3.0% of patients underwent thoracoscopic resection, and 16.4% of patients underwent endoscopic resection (Table 1).…”