Endoscopic submucosal dissection in a patient with esophageal adenoid cystic carcinoma

Figure 1 Preoperative endoscopy. A: Normal white light; B: Narrow band imaging with magnification; C: Endoscopic ultrasound, showing a tumor that was hypoechoic and homogeneous with a thickened hyperechoic submucosa slight irregularity of the third layer (white arrow); D: Lugol’s solution application.

Figure 2 Intraoperative endoscopy. A: Marking of lesion; B: Incision of lesion perimeter; C: Resected surface after excision; D: Excised specimen.

Figure 3 Postoperative endoscopy. A: 2 d postoperatively; B: 6 mo postoperatively.

Figure 4 Hematoxylin and eosin staining of the resected specimen. A: Main locus of submucosal tumor (× 40); B: Tumor protrusion into esophageal lumen (black arrows, × 40); C: Cribriform structure of tumor cells (× 100); D: Heterotypic cells with eosinophilic cytoplasm (black arrows, × 200); E: Bi-layered structure of tumor duct cells (black arrows, × 400).

Figure 5 Immunostaining of resected specimen. A: Cytokeratin CAM 5.2 staining (× 200); B: Epithelial membrane antigen staining (× 200); C: Carcinoembryonic antigen staining (× 200); D: p63 staining (× 200); E: Alpha-smooth muscle actin staining (× 200); F: Calponin staining (× 200).