UCTN ± Unusual cases and technical notes E237

Early adenocarcinoma originating in submucosal gland of thoracic esophagus presenting as submucosal tumor

Fig. 1 Endoscopic images of the esophageal lesion. a Initial endoscopic appearance. b Endoscopic ultrasound image. c Endoscopic appearance after mu− cosectomy.

Therefore, there are still debates about endoscopic mucosal resection as a treat− ment for early esophageal cancer [4,5]. In our reported case, the adenocarcinoma arose in the submucosal gland, not in epi− thelium. The definition of this tumor as “early stage” may be somewhat contro− versial. In this case, we considered that local Fig. 2 Histopathological analysis showed a tubular adenocarcinoma arising in the submucosal treatment alone was not contraindicated, glands (H&E stain; ” 40). since both endoscopic image and patho− logical section showed complete resec− tion, and endoscopic ultrasonography The most common malignant neoplasm The resected specimen measured and chest CT scan gave no evidence of of the esophagus is squamous cell carci− 1 ” 0.5 ” 0.5 cm. Microscopically, a sub− lymph node metastasis. noma. The majority of adenocarcinomas mucosal tumor composed of distorted of the esophagus originate in the esopha− tubular glands with an infiltration Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB gogastric junction, Barrett’s esophagus, or growth pattern was noted. The tumor ectopic gastric mucosa [1]. Adenocarcino− was confined to the submucosa without S.−W. Wang1, C.−S. Chang1,4, J. Wang2, ma arising in a submucosal gland of the involvement of either overlying epithe− H.−Z. Yeh1,3 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. esophagus beneath the squamous epithe− lium or muscularis propria. Diagnosis 1 Division of Gastroenterology, Taichung lium is rare [2]. was a tubular adenocarcinoma arising in Veterans General Hospital, Taichung, A 43−year−old woman with an esophageal the submucosal glands (l" Fig. 2). Taiwan submucosal lesion about 1 cm in size, lo− After an explanation of the risks of possi− 2 Department of Pathology, Taichung cated 24 cm from the incisors (l" Fig. 1a), ble aggressive behavior of adenocarcino− Veterans General Hospital, Taichung, underwent endoscopic ultrasonography ma of the esophagus, the patient still re− Taiwan that revealed an isoechoic lesion about fused surgery or adjuvant radiation ther− 3 School of Medicine, National Yang Ming 0.5 cm in size over the deep mucosal and apy. To date (18 months of follow−up), University, Taipei, Taiwan submucosal layers of the esophageal wall there has been no evidence of recurrence 4 Institution of Medicine, Chung Shan (l" Fig. 1b). or metastasis. Medical University, Taichung, Taiwan The patient underwent endoscopic mu− There were some concerns: increased cosal resection using the cap method depth of tumor invasion increases the (EMRC) without complications risk of lymph node metastases [3], and (l" Fig. 1c). endoscopic therapy for tumors with sub− mucosal invasion may overlook this risk.

Wang S−W et al. Early adenocarcinoma originating in the submucosal gland¼ Endoscopy 2008; 40: E237±E238 E238 UCTN ± Unusual cases and technical notes

References Bibliography Corresponding author 1 Christensen WN, Sternberg SS. Adenocarci− DOI 10.1055/s−2008−1077680 H.−Z. Yeh, MD noma of the upper esophagus arising in ec− Endoscopy 2008; 40: E237±E238 Division of Gastroenterology, topic gastric mucosa. Two case reports and  Georg Thieme Verlag KG Stuttgart ´ New York ´ Taichung Veterans General Hospital review of the literature. Am J Surg Pathol ISSN 0013−726X No. 160, Sec. 3, Chung−Kang Road 1987; 11: 397± 402 Taichung 2 Endoh Y, Miyawaki M, Tamura G et al. Esoph− Taiwan ageal adenocarcinoma that probably origi− Fax: +886−4−23741331 nated in the esophageal gland duct: a case [email protected] report. Pathol Int 1999; 49: 156 ± 159 3 Shimada H, Nabeya Y, Matsubara H et al. Prediction of lymph node status in patients with superficial esophageal carcinoma: a− nalysis of 160 surgically resected cancers. Am J Surg 2006; 191: 250 ± 254 4 Pech O, May A, Gossner L et al. Curative en− doscopic therapy in patients with early esophageal squamous−cell carcinoma or high−grade intraepithelial neoplasia. En− doscopy 2007; 39: 30± 35 5 Rahden BH von, Stein HJ. Endoscopic muco− sal resection as curative therapy for esoph− ageal cancer is inappropriate and should be discouraged. Endoscopy 2008; 40: 169 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Wang S−W et al. Early adenocarcinoma originating in the submucosal gland¼ Endoscopy 2008; 40: E237 ±E238