First Reported Case of Endoscopic En Bloc Resection of Esophageal Liposarcoma
Recommended Citation
Jamali T, Pimentel J, Perry K, Tocco J, Tejwani S, Mayerhoff R, Pompa R. First Reported Case of Endoscopic En Bloc Resection of Esophageal Liposarcoma. Am J Gastroenterol 2023; 118(10):S2186-S2186-S2187.
Document Type
Conference Proceeding
Publication Date
10-25-2023
Publication Title
Am J Gastroenterol
Abstract
Introduction: Well-differentiated sarcomas of the esophagus have been rarely reported in the literature with less than 100 cases reported to date. Here, we present the first described case of esophageal liposarcoma removed via en bloc endoscopic mucosal resection (EMR). Case Description/Methods: A 58-year-old man with a 15-pack-year smoking history reported 4 years of progressively worsening dysphagia to solids. He denied any weight loss. He underwent upper endoscopy with endoscopic ultrasound and was noted to have an elongated, pedunculated, esophageal nodule encountered between 15 cm and 25 cm from the incisors (Figure 1). This lesion originated from the muscularis mucosa layer on ultrasound. It was resected by first clipping the stalk. Then, 1:500,000 dilute epinephrine mixed with methylene blue was injected at the base. A hot snare was used to resect the polyp using cautery, and it was retrieved. Pathology revealed well-differentiated liposarcoma. Fluorescent in situ hybridization was performed and was positive for 12q12 (MDM2) gene amplification. Further therapy was not recommended due to negative pathologic margins. Repeat upper endoscopy at 2 and 6 months after initial endoscopy revealed scant, redundant tissue at the prior resection site. This area was biopsied, and pathology was negative for neoplasia. Redundant soft tissue was noted endoscopically in the hypopharynx immediately proximal to the vocal cords. Pathology was negative for neoplasia. The patient was referred to otolaryngology for resection of the hypopharyngeal tissue due to tenuous position near the vocal cords. The patient was otherwise asymptomatic. Discussion: This case demonstrates management of a very rare esophageal neoplasia. Though there have been reports of resection with endoscopic submucosal dissection (1), surgical (2), and piecemeal techniques (3), this is the first reported case of en bloc resection via EMR. Given the paucity of literature in this field, this case can help to guide endoscopic management for therapeutic endoscopists who encounter this phenomenon in the future.
Volume
118
Issue
10
First Page
S2186
Last Page
S2186-S2187
