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Erschienen in:
24.08.2017 | GI Image
Giant Esophageal Liposarcoma
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 2/2018
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A 51-year-old male presented with dizziness, fatigue, and melena, associated with progressively worsening dysphagia and unintentional 35-lb weight loss. A prior esophagogram showed a “Zenker’s diverticulum” by report and a prior esophagogastroduodenoscopy (EGD) mild esophagitis. He was tachycardic, normotensive, but anemic with a hemoglobin level of 5.7 mg/dL. At our institution, a barium esophagogram demonstrated a possible stricture of the cervical esophagus with distal esophageal dilation (Fig. 1a). EGD demonstrated a hard, necrotic 5-cm mass in the cardia of the stomach that appeared to be extending from the esophagogastric junction (EGJ) (Fig. 1b). A computer tomography (CT) showed an esophageal mass involving the length of the esophagus (Fig. 1c). Endoscopic ultrasound (EUS) identified a hypoechoic solid mass lesion extending 20 cm from the incisors down to the EGJ at 40 cm (Fig. 1d). Given these findings and his symptoms, but no definitive diagnosis, an exploratory thoracotomy. Intraoperatively, the esophageal muscle was intact (Fig. 2a). A myotomy was made and the tumor identified. Incisional biopsy with the frozen section was negative for malignancy. The tumor did not involve the muscle. The mass could be easily “shelled out” of the esophagus, thus preserving the esophagus (Fig. 2b). The final pathological diagnosis was a well-differentiated myxoid liposarcoma.
Fig. 1
a A barium esophagogram demonstrating what was initially thought to be a cervical esophageal stricture with distal dilation. The tumor was so large, filling the entire esophagus, that it was misinterpreted as dilation. b A retroflexed view of the tumor via an EGD. The necrotic mass is visible. Interestingly, as with the esophagogram, the tumor could not be readily distinguished in the esophagus because it filled the entire esophagus and was submucosal; therefore, it did not “stand out” endoscopically. c A CT scan showed a mass filling the esophagus and no signs of metastasis. Beyond that, one nature of the mass could not be determined. d An EUS confirmed that the lesion was solid in nature
Fig. 2
a An intraoperative photo showed that the esophageal muscle layer was intact and the esophagus itself was thick and hard. b Despite the size, the tumor “shelled out” of the submucosal plane easily, more consistent with a leiomyoma, leaving the muscle layer and mucosa intact
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