PMC5377431_01
Endoscopic examination findings.. Endoscopic examination shows submucosal tumor in the upper thoracic esophagus.
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Endoscopic examination showed an esophageal submucosal tumor 4 cm in diameter in the upper thoracic esophagus (Fig. 1).
Enhanced upper gastrointestinal series findings.. Enhanced upper gastrointestinal series shows the lesion appearing as a smooth, rounded, filling defect with sharp demarcation as well, as on endoscopy.
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In an enhanced upper gastrointestinal series, the lesion appeared as a smooth, rounded filling defect with sharp demarcation resembling a submucosal mass lesion, displacing the adjacent trachea (Fig. 2).
CT findings.. Contrast-enhanced chest computed tomography reveals a 4.3 x 3.0-cm mass (arrow) displacing the adjacent trachea, arising along the anterior wall of the esophagus in the upper thoracic part at the level of the aortic arch.
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Chest computed tomography (CT) revealed a 4.3 x 3.0-cm, round mass lesion arising along the anterior wall of the esophagus in the upper thorax at the level of the aortic arch, appearing as a hypovascular mass without paraesophageal lymphadenopathy (Fig. 3).
Intraoperative findings.. a) The capsule of the tumor is exposed after cutting the mediastinal pleura, and the adventitia of the esophagus and muscularis propria layer are cut longitudinally using electrocautery.. b) The tumor has been completely enucleated by almost blunt dissection without injuring the esophageal mucosa.
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The mediastinal pleura, adventitia of the esophagus and muscularis propria layer were cut longitudinally using an electrosurgical knife to expose the tumor capsule (Fig. 4a). The tumor seemed to mainly arise from the lamina muscularis mucosae, and a round, elastic-hard tumor was successfully enucleated by almost blunt dissection without injury to the mucosa (Fig. 4b).
Microscopic findings.. a) Hematoxylin-eosin staining shows proliferation of spindle-shaped tumor cells forming interlacing and fascicles. Cellularity is relative low, and neither coagulation necrosis nor high mitotic activity of the tumor were noted.. b) Immunohistochemically, spindle-shaped tumor cells were diffusely positive on desmin staining.
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Histopathological examination of the resected specimen showed spindle-shaped tumor cells (Fig. 5a), appearing diffusely positive for desmin, but negative for DOG-1, c-KIT, CD34, and S100 on immunohistochemical examination (Fig. 5b).