PMC8548363_01
Endoscopic findings in a 77-year-old woman with dysphagia. (A) Upper gastrointestinal endoscopy showed a large, rounded mass with smooth normal overlying mucosa, which is seen extending longitudinally along the lower esophagus, 30-34 cm from the incisor teeth. (B) EUS shows a well-demarcated, hypoechoic mass in the esophagus wall, clearly margined from the surrounding adventitia.
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F1
Upper gastrointestinal endoscopy revealed a large rounded esophageal submucosal mass covered by normal mucosa, located at the lower esophagus, 30-34 cm from the central incisors (Figure 1A). Endoscopic ultrasonography (EUS) showed a well-demarcated hypoechoic mass chiefly located in the esophageal wall (Figure 1B), clearly separated from the surrounding adventitia.
Chest contrast-enhanced computed tomography at diagnosis. (A) (Coronal plane) and (B) (Sagittal plane) CT scan revealed a well-defined homogeneous soft tissue mass at the lower esophagus (red arrow).
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F2
Findings on chest contrast-enhanced computed tomography (CT) revealed a well-defined homogeneous mass in the lower esophageal region, with size 18 mm x 28 mm (Figures 2A,B).
Images during endoscopic submucosal dissection. Endoscopic submucosal tunnel dissection is performed without any complication. (A) Initial incision of the mucosa after injection. (B) Exposure of the tumor. (C) The wound after ESD. (D) Complete closure of the mucosal incision site with endoclips. (E) On the external surface of the resected specimen. (F) On the cut surface of the resected specimen.
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F3
The mucosal incision site was closed with endoscopic clips (Figures 3A-D). The resected specimen measured 4.3 cm x 2.8 cm x 1.5 cm (Figures 3E,F).
Pathological images of the resected specimen. (A) The histological section shows lymphoid hyperplasia in the lamina propria and submucosa (H&E stain, orig. mag. x200). Immunohistochemistry revealed that the lymphoma cells are positive for CD20 (B), CD19 (C), PAX5 (D), and BCL2 (E), and negative for CD3 (F), CD5 (G), CD10 (H), and cyclin D1 (I) (orig. mag. x200).
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F4
The histopathological findings of the resected specimen showed infiltration of small- to medium-sized lymphoid cells with slightly irregular dark nuclei and abundant cytoplasm (Figure 4A). Immunohistochemical studies revealed that the lymphoid cells were positive for CD20 (Figure 4B), CD19 (Figure 4C), PAX5 (Figure 4D), as well as BCL2 (Figure 4E), and negative for CD3 (Figure 4F), CD5 (Figure 4G), CD10 (Figure 4H), and cyclin D1 (Figure 4I).