Esophageal leiomyosarcoma: a case treated by endoscopic resection

Abstract

We report a rare case of leiomyosarcoma of the lower esophagus that was treated by endoscopic resection. A 56-year-old man was referred to our hospital in October 2005 because of mild discomfort around the lower esophagus upon swallowing for 2 months. The esophagogram showed a fi lling defect at the lower esophagus. It revealed a giant polyp tumor arising from the right wall of the lower esophagus. The diameter of the top of the tumor was 25 mm. Upper gastrointestinal endoscopic study revealed that the lesion was a tumor with a large stalk at the right side in the lower esophagus. The lesion was at 38 cm from the incisors. Histological study of the biopsy samples revealed the tumor was a leiomyosarcoma by morphological features of the tumor in hematoxylin and eosin stain. Computerized tomographic (CT) scan showed the tumor protruded into the lumen of the lower esophagus but into none of the lymph nodes, nor was distant metastasis seen. Endoscopic resection was performed with an electric snare. The tumor was completely resected without any trouble. The tumor was composed of spindle cells with irregular nuclei and numerous mitotic fi gures were present. The immunohistochemical staining showed positive for p53. The Ki67 labeling index was 8.7%, which was consistent with leiomyosarcoma. It also showed positive for smooth muscle actin, caldesmon, and calponin but negative for c-kit, CD34, and S-100. These histopathological fi ndings disclosed a leiomyosarcoma. The patient is asymptomatic and disease free after a 2-year follow up. We believe that endoscopic resection will be an option for an intraluminal polypoid form of esophageal leiomyosarcoma.

Esophageal intramural squamous cell carcinomas presenting as subepithelial lesions removed by endoscopic submucosal dissection

“…In addition to the abovementioned epithelial-derived esophageal malignancies, mesenchymal malignancies can occur in the esophagus. Tatsushi et al [ 17 ] first reported an intraluminal polypoid form of esophageal leiomyosarcoma treated with endoscopic resection with an electric snare in 2008. Yamamoto et al [ 18 ] performed en bloc resection by ESD for the therapeutic diagnosis of leiomyosarcoma in cases where several biopsy specimens could not confirm the pathology results and the tumor had rapidly grown.…”

Thoracoscopic Esophagectomy for a Huge Leiomyosarcoma

“…To the best of our knowledge, thoracoscopic mobilization for leiomyosarcoma of the esophagus has not been described in literature. Apart from a mention of two minimally invasive approaches without details in a case series of esophageal sarcomas in general 3 and isolated endoscopic and local resections for small polypoidal variants, 4 5 the vast majority of esophageal leiomyosarcomas have been resected through the open approach. 6 7 8 9 10 The reason probably is the fact that these tumors have been known to attain sizes as large as 16 cm in length and present as mediastinal masses with deep ulcerations.…”

Polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection

“…Suwa et al . first reported a case of intraluminal polypoid leiomyosarcoma treated without any trouble by endoscopic resection using an electric snare . Polypoid type, early stage, and good differentiation of esophageal leiomyosarcomas have been shown to represent favorable prognostic factors, so endoscopic resection may be a useful choice for polypoid‐type leiomyosarcoma with no metastasis.…”

“…Leiomyosarcomas usually show slow growth and late metastasis, and carry a good prognosis . Treatment mostly involves surgical excision, so few cases with endoscopic resection have been described . 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.…”