Clin Endosc.  2013 Mar;46(2):182-185. 10.5946/ce.2013.46.2.182.

A Submucosal Tumor-Like Recurrence of Early Esophageal Cancer after Endoscopic Submucosal Dissection

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. doc0224@pusan.ac.kr
  • 2Department of Pathology, Pusan National University School of Medicine, Busan, Korea.
  • 3Department of Chest Surgery, Pusan National University School of Medicine, Busan, Korea.

Abstract

Early esophageal cancer is defined as a tumor invading the mucosa with or without lymph node or distant organ metastasis. In the current guidelines for early esophageal cancer, absolute indication for endoscopic resection include lesions limited to the epithelium or lamina propria mucosa not exceeding two-thirds of the circumference, and relative indications include lesions limited to the muscularis mucosa or the upper third of the submucosal layer and not accompanied by clinical evidence of lymph node metastasis. After endoscopic submucosal dissection for early esophageal cancer, locally recurrent cancer can occur, especially in the case of incomplete resection. Here, we report a rare case of a submucosal tumor-like recurrence after endoscopic resection of early esophageal cancer.

Keyword

Esophageal neoplasms; Endosonography; Endoscopic resection; Recurrence

MeSH Terms

Endosonography
Epithelium
Esophageal Neoplasms
Lymph Nodes
Mucous Membrane
Neoplasm Metastasis
Recurrence

Figure

  • Fig. 1 Endoscopic and histologic findings at the time of endoscopic submucosal dissection (ESD) and follow-up. (A) A 1.5-cm superficial elevated lesion was observed in the lower esophagus (33 cm from the incisor teeth). (B) This lesion was resected by ESD. (C) Histologic findings revealed that the lesion had invaded the muscularis mucosa (H&E stain, ×200). Because the distal margin of the resected specimen was positive for carcinoma, additional argon plasma coagulation was employed. (D) On follow-up endoscopy (18 months after ESD), no recurrence was observed.

  • Fig. 2 Endoscopic, endoscopic ultrasonography (EUS), and histologic findings at the time of recurrence. (A) A submucosal tumor-like lesion with central nodular change was seen at the previously resected area. (B) After lugol spraying, only the central nodular area was unstained. (C) Magnified endoscopy with narrow band imaging showed an abnormal microvascular pattern in the central nodular area. (D) EUS revealed that the tumor had invaded the muscularis propria. (E) Gross findings after esophagectomy included a relatively ill-defined white solid mass in the submucosa and muscularis propria measuring 1.5×1.5 cm. (F) Histological examination showed that the lesion had invaded the adventitia and had a mixed infiltrative and expanding growth pattern (H&E stain, ×200).


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