PMC3657434_01
(a) CT scan of the chest, showing a well-circumscribed 5 cm submucosal esophageal mass. (b) Intraoperative view of the tumor (inset: macroscopic view of the resected specimen).
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After a chest radiograph failed to show any pathology, a computed tomography (CT) scan was ordered which revealed showed a 5 cm mass on the midesophagus at the junction of the azygos vein with the superior vena cava (Figure 1). The mass was approached via a right posterolateral thoracotomy (Figure 1). On macroscopic examination, the mass was 5.5 x 3.5 x 1.5 cm in size and grayish in color with a fasciated texture (Figure 1).
Microscopic view of the tumor. (a) H/E x40 (inset H/E X200), (b) c-kit x200, (c) Ki-67 x200, and (d) SMA (a smooth muscle actin) x200.
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Histologically the mass corresponded to an encapsulated mesenchymatous neoplasm, consisting of fibrous and muscle fascicles with sparse round and spindle cells (Figure 2(a)). The diagnosis of a GIST was established by immunohistochemistry, which revealed a positive immunoreaction to c-kit and CD34 (Figures 2(b) and 2(c)). There was also an unusual positive reaction to smooth muscle actin (SMA) (Figure 2(d)).