Huge Liposarcoma of Esophagus Resected by Endoscopic Submucosal Dissection: Case Report with Video
A 44-year-old male patient was admitted to our hospital for 4 months of dysphagia which was exacerbated during the recent weeks. An abdominal computed tomography (CT) scan showed a 15 cm long mass protruding into the esophageal lumen on coronal image. The majority of the tumor showed fat attenuation, internal septa-like structures, and soft tissue density ().\nOn esophagogastroduodenoscopy (EGD), there was a yellowish, soft, and movable subepithelial tumor (SET) located 20 to 35 cm away from the upper incisor. There was 4 cm sized stalk just below the upper esophageal sphincter (). Endoscopic ultrasonography showed a nonhomogeneous submucosal mass located in the posterior wall of upper to mid esophagus (). Although the tumor had a stalk, the stalk was too huge to use a snare. So we performed ESD on the patient under general anesthesia with nasal intubation. The procedure was done using a cap-fitted gastroscope (GIF-Q260; Olympus, Tokyo, Japan). After submucosal injection of cerol mixture (glycerin 10%, fructose 5%; Cheiljedang Pharma Corp., Seoul, Korea), the first incision was made using a fixed flexible knife (Kachu Technology, Seoul, Korea) at the center of the stalk. After exposing the submucosal tissue, the mass was dissected along the stalk using the IT-2 knife (KD-611L; Olympus Medical Systems Co., Tokyo, Japan) (, , available online at ).\nMacroscopically, the tumor had a three fingers-like shape and was measured 8.7×6.0×3.0 cm. Its surface was covered by normal esophageal mucosa with small erosion in some area. The cut end of the mass revealed multilobulating contoured mass, which was located in the submucosal layer and had yellow color (). Histologically, the neoplasm consisted predominantly of mature looking fat tissues which were in variable sizes and the shape of adipocytic element. The lipocytes were divided by fibrous septa. Some lipocytes showed big and bizarre nucleuses, suggesting liposarcoma rather than lipoma ().\nThe tumor had the characteristic features of well-differentiated liposarcoma in general. In some other areas, there were lobules of mature adipose tissue with a delineated myxoid tumor in the subepithelial stroma. The cellularity was low and cellular pleomorphism was mild to moderate. Tumor necrosis was not seen. Following ESD, the patient was followed up for 4 months by chest CT and EGD, and signs of recurrence and metastasis have not been found so far ().