Smooth muscle tumors of the esophagus: clinicopathological findings in six patients

Huge spindle cell sarcoma of esophagus in a middle-aged man with a recent-onset dysphagia: Case report

INTRODUCTION

Esophageal sarcoma is a rare neoplasm of the gastrointestinal tract. The majority of the esophageal neoplasms have an epithelial origin. In this report, we present a case of a middle-aged man with an enormous spindle cell sarcoma whose symptoms initiated only a few weeks before diagnosis.

PRESENTATION OF CASE

A 41-year-old man with an unremarkable past medical history and physical examination presented with recent aggravation of cough and severe, progressive dysphagia to solid foods resulting in a 25-kilogram weight loss without any prior symptoms. He had no history of cigarette smoking and alcohol consumption. The CT scan showed a huge soft tissue mass with heterogeneous enhancement from the proximal esophagus to 4 cm above the gastro-esophageal junction, causing luminal bulging. Trans-hiatal esophagectomy and gastric pull-up were performed. Pathology report confirmed the diagnosis of sarcoma. Further pathological evaluation using immune-histochemical studies, confirmed the tumor as spindle cell sarcoma. The postoperative period was uneventful, and there were no signs and symptoms related to tumor recurrence one year after surgery.

DISCUSSION

The most challenging aspect of diagnosing sarcomas is differentiating them from other pathologies, such as gastrointestinal stromal tumors, synovial sarcomas, sarcomatoid carcinomas, melanomas, and solitary fibrous tumors. Immunohistochemical studies play a vital role in this differentiation. Additionally, cytokeratin AE1/AE3 has been introduced as a marker of epithelial differentiation and can verify the presence of the epithelial component in tumors, such as in carcinosarcomas.

CONCLUSION

Considering the potential for an unusual size, sarcoma should be considered in a differential diagnosis for huge esophageal masses.

Radiotherapy treatment of large esophageal leiomyosarcoma: A case report

Leiomyosarcoma of the esophagus is a rare type of tumor, characterized by a malignant phenotype and smooth muscle histology. Previously, barium studies have been used to identify areas of luminal narrowing, expansile intraluminal masses or large intramural masses with ulceration or tracking. Furthermore, endoscopic biopsies appear to be associated with a high false negative rate, particularly in cases where the mucosa is intact. The optimal treatment strategy is surgical resection, while the role of adjuvant radiotherapy and chemotherapy is controversial. In addition, the prognosis of patients with leiomyosarcoma of the esophagus is improved compared with patients suffering from squamous esophageal cancer. The present study described the case of a 48-year-old woman who presented with dysphagia and was diagnosed with a large leiomyosarcoma of the esophagus. The patient was successfully treated with radiotherapy and remains disease-free two years after the completion of treatment. In addition, the present study conducted a review of the relevant literature, reporting previous cases of esophageal leiomyosarcoma and potential strategies for the management of this disease.

Esophageal leiomyosarcoma: clinical analysis and surgical treatment of 12 cases

Leiomyosarcoma of the esophagus is a rare malignant tumor with slow growth and late metastasis. The aim of this study was to reassess the clinical characteristics and treatment modality in one of the largest series of esophageal leiomyosarcomas from a single institution. From February 1973 to December 2011, 12 cases of esophageal leiomyosarcoma were identified. The principal symptoms included progressive dysphagia in 11 cases (91.7%), retrosternal/back pain in four (33.3%), weight loss in four (33.3%), upper gastrointestinal hemorrhage in two (16.7%), and emesis in two (16.7%). The average duration of symptoms was 10.6 months. The location of the primary tumor was in the middle thoracic esophagus in five cases, and lower thoracic esophagus in seven cases. Six cases were classified as the polypoid type, five cases as the infiltrative type, and only one case as the intramural type. All 12 of the patients underwent esophagectomies, and radical resections were achieved in these patients. Based on the Kaplan-Meier Method, the 3-, 5-, and 10-year survival rates were 80.0%, 58.3%, and 31.1%, respectively, with a median survival of 63 months. Five-year survival rates for patients with polypoid or intramural tumors (n = 7) was 83.3%, and for patients with infiltrative tumor (n = 5) it was 25.0%. One of the patients had tumor resected four times and survived for 161 months. In conclusion, patients presenting with esophageal leiomyosarcomas have an excellent prognosis, and radical resection may achieve acceptable results.

Giant leiomyoma of the oesophagus with eosinophilic infiltration

The most common benign tumour of the oesophagus is leiomyoma. Haemopoietic elements rarely infiltrate oesophageal leiomyoma. We report the case of a 24-year-old man with a long history of intermittent dysphagia. Endoscopy revealed external compression with normal oesophageal mucosa. A barium swallow study showed a defect in the oesophageal wall and a narrow oesophageal lumen. A CT scan of the chest confirmed a mass in the mid-oesophagus. A tumour was excised and the histology report revealed leiomyoma infiltrated with eosinophils, which is a rare variant.

Solitary esophageal leiomyoma with eosinophilic infiltrate: case report and review of the literature

Leiomyomas are common benign tumors of the esophagus representing 10% of all mesenchymal tumors of the gastrointestinal tract. Prominent numbers of eosinophils involving a leiomyoma have only rarely been described. They have never been described involving a solitary leiomyoma of the esophagus. We present an unusual case of a solitary esophageal leiomyoma with a prominent number of eosinophils and mast cells, review the previous literature regarding this topic and discuss possible causes of the eosinophil infiltrate.

Giant esophageal squamous papilloma: a case report

Esophageal papilloma is a rare disorder that may cause hypopharyngeal symptoms. This patient was a 56-year-old man who presented with cough and choking symptoms. After the initial negative laryngoscopy, a fiberoptic endoscopy revealed a mass originating from the hypopharyngeal area, which was resected surgically and found to be non-malignant.

Robotic-assisted thoracoscopic resection of esophageal leiomyoma

Esophageal leiomyoma represents 70-80% of all benign esophageal tumors but only approximately 0.5% of all esophageal neoplasms; optimal surgical treatment consists of local resection. We present the first reported robotic-assisted thoracoscopic resection of two patients with esophageal leiomyoma using the daVinci Surgical System. Operative technique and technical considerations are presented.