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a. Esophagogram revealed a spherical and apparently-circumscribed filling defect from the middle to the lower esophagus. b. Enhanced CT showed the evenly enhanced mass mainly in the left esophageal wall. The mass displaced the left inferior bronchus ventrally. c. The tumor was in contact with the aorta and the left pulmonary vein.
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A 64-year-old man had dysphagia and underwent gastroendoscopy. A submucosal tumor with bridging folds was found from the middle to the lower esophagus. Although fine needle aspiration biopsy revealed esophageal leiomyoma, FDG-PET/CT showed high-level FDG accumulation with a maximum standardized uptake value of 11.3 in the tumor and the tumor was su...
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Citations
... We also supposed the tumor to be GCT, which was possible to remove endoscopically, because it was yellowish and low echoic, even if it was atypical due to the increased FDG uptake. There were also a few reports that showed increased FDG uptake in benign leiomyoma, which is the most common submucosal tumor that develops in the [14,15]. Therefore, we had to confirm the definite diagnosis of esophageal submucosal tumor to decide a plan of treatment. ...
For an esophageal submucosal mass suspicious of granular cell tumor (GCT) based on gross appearance and endoscopic ultrasound findings, a sufficient number of biopsy specimens is required for a definite diagnosis using immunohistochemical examination. When the specimen obtained by forceps biopsy is insufficient, endoscopic ultrasound-fine needle aspiration (EUS-FNA) is believed to be an useful alternative. However, it may be difficult to obtain an adequate amount of tumor material using EUS-FNA. Mucosal incision-assisted biopsy (MIAB) is a simple method that can collect larger amounts of specimens. This procedure is helpful for physicians who encounter the problem of obtaining an adequate amount of biopsy material from esophageal tumors suspicious for GCT. We present a case of esophageal GCT that was successfully diagnosed through MIAB.
A 24-year-old man was referred to our hospital for a suspected mediastinal tumor found on chest X-ray in a health check-up. CT showed a tumor with a maximal lateral diameter of 8 cm circumferentially located from the thoracic esophagus to abdominal esophagus. Boring biopsies were performed endoscopically and the pathological diagnosis was esophageal leiomyoma. The patient was suffering from heartburn and dysphagia caused by the tumor compressing and expanding the esophagus. Tumor enucleation was performed using laparoscopy and thoracoscopy. The tumor extended subcircumferentially along the longitudinal esophageal axis and was of length approximately 17 cm. After tumor enucleation, the muscular layer was circumferentially dissected from the middle thoracic esophagus to abdominal esophagus, where the mucosal layer alone was preserved. Anti-reflux fundoplication was also performed to prevent gastroesophageal reflux. The postoperative course was good and the patient was discharged on postoperative day 19. There have been few reports on enucleation of giant esophageal submucosal tumors. We report this case as an example of a giant submucosal esophageal leiomyoma treated by laparoscopic and thoracoscopic enucleation.
Leiomyomas are benign tumors that are often negative on ¹⁸F-FDG-PET. Here, we report two relatively rare cases of gastric leiomyoma with increased FDG accumulation. In case 1, a 49-year-old man was admitted to our hospital for a submucosal tumor that showed strong FDG accumulation with a maximum standardized uptake value (SUVmax) of 8.17 from the esophagogastric junction to the gastric cardia. In case 2, a 27-year-old man visited our hospital because of an abnormal examination. A submucosal tumor with an ulcer was found in the gastric cardia. FDG-PET showed abnormal FDG accumulation with SUVmax 6.13. In both cases, laparoscopic proximal gastrectomy was performed based on the possibility of malignancy, and both tumors were diagnosed as gastric leiomyoma. The causes of increased FDG accumulation in leiomyoma may be increased blood flow in the tumor and overexpression of glucose transporter. A differential diagnosis is required because even benign leiomyoma may show false positives on FDG-PET. It is difficult to distinguish between benign and malignant myogenic submucosal tumors using a non-invasive method, and there is a need for establishment of appropriate examinations.
A 64-year-old woman complaining of dysphagia visited our hospital. An esophagogastroduodenoscopy (EGD) revealed a type-2 tumor at MtUt of the esophagus. Biopsy and chest CT scan led to the diagnosis of squamous cell carcinoma of the esophagus, T3N1M0 in Stage III. Although biweekly DCF therapy was started, it was discontinued due to severe liver dysfunction. Then she underwent definitive concurrent chemoradiotherapy (CRT) with low-dose FP, followed by S-1 therapy for one year. A PET-CT scan after the S-1 therapy revealed local uptake of FDG with 3.3 of standardized uptake value max in the primary lesion. However, biopsy in EGD and CT could not make the definitive diagnosis, and we performed salvage operation for suspected relapse of esophageal carcinoma. The histopathological examination revealed no cancer cell residue in the entire specimens including harvested lymph nodes. She is free of recurrence as of one year after the treatment. The main diagnostic modalities after CRT for esophageal carcinoma are EGD and CT. A PET-CT-based evaluation is reported to be valuable when other modalities cannot detect the existence of cancer cells. However, further studies are warranted to clarify the usefulness of PET-CT as a diagnostic tool in terms of the sensitivity, specificity, viability evaluation of tumors, and evaluation of treatment.
We report a rare case of a primary leiomyoma found in the greater omentum of the gastric tube after esophagectomy. This case involved differential diagnosis to distinguish from recurrence of esophageal cancer. A 62-year-old man underwent subtotal esophagectomy with three-field lymphadenectomy through a right thoracotomy and esophageal reconstruction using a gastric tube through the subcutaneous route. The pathological examination of the resected specimen showed a basaloid-squamous cell carcinoma. The pathological stage was pT3, pN0, pM0, pStage II. He did not receive any adjuvant therapy. During follow-up, a small lesion was found in the left side of the subcutaneous gastric tube, at ten months after surgery. Lymph node metastasis or dissemination of the omentum was suspected. Since the reconstruction route was subcutaneous, this new lesion was anatomically easily to reach, and was resected. After resection the lesion was confirmed histologically to be a primary leiomyoma.
