Korean J Gastroenterol.  2024 Jun;83(6):243-246. 10.4166/kjg.2024.047.

Effective Endoscopic Submucosal Dissection of a Huge Esophageal Liposarcoma: A Case Report

• Lee MJ
• Lee MW
• Joo DC
• Hong SM
• Baek DH
• Lee BE
• Kim GH
• Song GA

• KMID: 2557111
• DOI: http://doi.org/10.4166/kjg.2024.047

Abstract

This case report presents the successful endoscopic submucosal dissection (ESD) of a well-differentiated esophageal liposarcoma in a 51-year-old male with persistent dysphagia. The cause was initially diagnosed as a 10 cm pedunculated lesion extending from the upper esophageal sphincter to the mid-esophagus. An ESD was chosen over traditional surgery because it is less invasive. The procedure involved a precise submucosal injection and excision with special techniques to manage bleeding from a central vessel. Despite the extraction challenges owing to the size of the lesion, it was successfully removed orally. A histopathological examination of the 8.3×4.2×2.3 cm specimen revealed the characteristic features of a well-differentiated liposarcoma, including MDM2 and CDK4 positivity. The follow-up revealed no recurrence, and active surveillance has been performed since. This report highlights the versatility of ESD in treating significant esophageal tumors and provides evidence for its efficacy as a minimally invasive alternative.

Keyword

Liposarcoma; Esophagus; Endoscopic mucosal resection

Figure

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  Fig. 1 Endoscopic findings of esophageal liposarcoma. (A) The tumor originated from the upper esophageal sphincter. (B) The tumor extended to the mid-esophagus and occupied most of the esophageal cavity. (C) Endoscopic ultrasound shows a homogeneous, hyperechoic lesion.

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  Fig. 2 Endoscopic submucosal dissection (ESD) procedure. (A) Submucosal injection and mucosal incision at the base of the tumor. (B) Completely removed after ESD. (C) Gross pathological resection showing the lesion was about 9 cm long.

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  Fig. 3 (A) Fibrous septa between the adipocytes revealed an increased number of stromal cells with slightly irregular, hyperchromatic nuclei scattered fibrous septa containing hyperchromatic spindle cells (H&E, ×400). MDM2 (B) and CDK4 (C) were positive in the fibrous septa and hyperchromatic spindle cells.

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