A 72-year-old male visited to our hospital suffering from chest pain that had been present for 1 mo. The patient had been diagnosed with colon cancer and received laparoscopic surgery 1 year prior. The physical examination was unremarkable. He was admitted to the cardiology department, and received electrocardiogram and cardiac single photon emission computed tomography, but no cardiac problem was found. Endoscopic examination demonstrated a stalked intraluminal polypoid mass in the mid esophagus, 30 cm from the incisor (Figure ). The tumor was large enough to fill the esophageal lumen, but allowed passage of a gastrofiberscope (Q260, Olympus, Tokyo, Japan) to the distal part of the esophagus. An endoscopic biopsy was performed, and the patient was suspected of leiomyoma and leiomyosarcoma. A computed tomography scan showed a large, well enhancing soft tissue mass in the mid esophagus (Figure ), but no regional lymph node enlargement or liver metastasis. Positron emission tomography/computed tomography (PET-CT) showed intense segmental F-18 fluorodeoxyglucose (FDG) uptake [Standardized Uptake Value (SUV) max 17.3] at the mid-thoracic esophagus. Compared with the previous PET-CT for colon cancer follow-up from 3 mo prior, there was only physiologic FDG uptake at the esophagus (Figure ). The patient underwent surgery; an esophagectomy with esophagogastrostomy. Macroscopically, the resected specimen was a polypoid tumor measuring 9.8 cm × 5.0 cm × 2.5 cm (Figure ). Histopathologically, the tumor consisted of pleomorphic spindle cells with mitosis and cell necrosis compatible with leiomyosarcoma (Figure ). Tumor invasion involved the muscularis propria, submucosa, and mucosa. Nine regional lymph nodes were free of metastasis. An immunohistochemical examination stained positive for smooth muscle actin, but negative for cytokeratin and S-100 protein (Figure ). These were stained by an automated Ventana immunohistochemical/in situ hybridization staining platforms machine (BenchMark XT). Squamous severe dysplasia and focal stratified squamous epithelial invasion into the lamina propria was also noted in the mucosa (Figure ). We diagnosed the patient with leiomyosarcoma combined with squamous cell carcinoma.
Endoscopic finding. A: Intraluminal polypoid mass; B: Stalk of the mass (arrow).
Computed tomography scan showed a large, homogeneously enhancing soft tissue mass.
Positron emission tomography/computed tomography. A: Positron emission tomography/computed tomography (PET-CT) showed intense segmental fluorodeoxyglucose uptake (SUV max 17.3) at mid esophagus; B: PET-CT performed at 3 mo ago.
Resected specimen measured about 9.8 cm × 5.0 cm × 2.5 cm.
Figure 5 Pathologic images. A: Pleomorphic spindle cells showing mitosis and cell necrosis compatible with leiomyosarcoma [hematoxylin and eosin (HE) stain, × 200]; B: Immunohistochemical stain was positive for smooth muscle actin (× 12); C: Squamous (more ...)
In the post-operative period, the patient recovered uneventfully and was discharged 18 d after operation. No adjuvant radiotherapy or chemotherapy was administered. At the last follow up visit to our hospital 2 mo after surgery, the patient was in good condition without any recurrence or distant metastasis.