title: Polypoid leiomyosarcoma of the esophagus treated by endoscopic submucosal dissection.
abstract: We report a rare case of polypoid leiomyosarcoma of the esophagus that was treated by endoscopic submucosal dissection (ESD). A 63-year-old man with complaints of progressive dysphagia was referred to Hyogo Cancer Center for treatment of esophageal tumor. Esophagoscopy revealed a polypoid tumor 25 mm in diameter on the left side of the upper esophagus. Despite several biopsy specimens, the diagnosis could not be confirmed. Computed tomography showed a protruded, homogeneously enhancing mass in the upper esophagus, but no lymph node enlargement or metastasis. After 1.5 months, the esophagogram showed a filling defect 47 mm in diameter in the upper esophagus. Given this rapid tumor growth, en bloc resection was done by ESD for therapeutic diagnosis. After this treatment, the tumor seemed to grow larger, showing a short stalk and occupying the esophageal lumen. Histopathologically, the tumor comprised pleomorphic spindle cells with mitosis. Tumor invasion involved the lumina propria mucosae and contact with the muscularis mucosae, but not involving the submucosa. Immunohistochemical examination showed positive staining for smooth muscle actin and HHF35, but negative for desmin, caldesmon, CD34, c-kit, DOG1, ALK, S-100 protein and cytokeratin. These histopathological findings were compatible with a diagnosis of esophageal leiomyosarcoma derived from the muscularis mucosae.
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Internal Medicine, Kaibara Hospital, Hyogo, Japan.
authors.forename: Hogara
authors.initials: H
authors.lastname: Nishisaki
authors.affiliation: Department of Pathology, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Yu-ichiro
authors.initials: Y
authors.lastname: Koma
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sawai
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Sakai
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Mimura
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Saeko
authors.initials: S
authors.lastname: Kushida
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Tsumura
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Tobimatsu
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Ikuya
authors.initials: I
authors.lastname: Miki
authors.affiliation: Department of Diagnostic Pathology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Sakuma
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Department of Clinical Laboratory, Osaka Medical Center, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mano
authors.affiliation: Department of Diagnostic Pathology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Department of Gastroenterology, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Inokuchi
mesh_terms: D001707:Biopsy, Needle; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007890:Leiomyosarcoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D011127:Polyps / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018570:Risk Assessment; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: dissection; endoscopic; esophagus; leiomyosarcoma; submucosal