Clin Endosc.  2015 Jul;48(4):322-327. 10.5946/ce.2015.48.4.322.

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

• Seo M
• Kim DH
• Cho YW
• Gong EJ
• Lee S
• Choi E
• Jung HY
• Kim JH

• KMID: 1964276
• DOI: http://doi.org/10.5946/ce.2015.48.4.322

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.

Keyword

Esophageal neoplasms; Leiomyoma; Endoscopic submucosal dissection

MeSH Terms

Epithelium
Esophageal Neoplasms*
Esophagus
Leiomyoma*

Figure

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  Fig. 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.

• 

  Fig. 2 (A) Histopathologically, the resected lesion is a squamous cell carcinoma that overlies a leiomyoma in situ. The red arrows correspond to the lateral margins of the squamous cell carcinoma (H&E stain, ×12.5). (B) The esophageal leiomyoma is composed of bland spindle cells with no mitosis or nuclear atypia (H&E stain, ×40). (C) The entire layer of atypical epithelial cells is positive for the Ki-67 stain and demonstrates a Ki-67 labeling index of less than 1% (×40). (D) The esophageal leiomyoma is strongly and diffusely positive for smooth muscle actin (×40).

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  Fig. 3 (A) Endoscopic examination shows a subepithelial tumor with a flat hyperemic lesion in the upper 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 superficial squamous cell carcinoma. (D) The specimen with the lesion after en bloc resection.

• 

  Fig. 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).

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  Fig. 5 (A) The endoscopic images show a subepithelial tumor with an eroded hyperemic lesion in the lower 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 high-grade dysplasia. (D) The specimen with the lesion after en bloc resection.

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