Esophageal leiomyosarcoma: a case treated by endoscopic resection

Abstract

We report a rare case of leiomyosarcoma of the lower esophagus that was treated by endoscopic resection. A 56-year-old man was referred to our hospital in October 2005 because of mild discomfort around the lower esophagus upon swallowing for 2 months. The esophagogram showed a filling defect at the lower esophagus. It revealed a giant polyp tumor arising from the right wall of the lower esophagus. The diameter of the top of the tumor was 25 mm. Upper gastrointestinal endoscopic study revealed that the lesion was a tumor with a large stalk at the right side in the lower esophagus. The lesion was at 38 cm from the incisors. Histological study of the biopsy samples revealed the tumor was a leiomyosarcoma by morphological features of the tumor in hematoxylin and eosin stain. Computerized tomographic (CT) scan showed the tumor protruded into the lumen of the lower esophagus but into none of the lymph nodes, nor was distant metastasis seen. Endoscopic resection was performed with an electric snare. The tumor was completely resected without any trouble. The tumor was composed of spindle cells with irregular nuclei and numerous mitotic figures were present. The immunohistochemical staining showed positive for p53. The Ki67 labeling index was 8.7%, which was consistent with leiomyosarcoma. It also showed positive for smooth muscle actin, caldesmon, and calponin but negative for c-kit, CD34, and S-100. These histopathological findings disclosed a leiomyosarcoma. The patient is asymptomatic and disease free after a 2-year follow up. We believe that endoscopic resection will be an option for an intraluminal polypoid form of esophageal leiomyosarcoma.