Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2019; 11(11): 541-547
Published online Nov 16, 2019. doi: 10.4253/wjge.v11.i11.541
Oesophageal carcinoma mimicking a submucosal lesion: A case report
Revathy Marimuthu Shanmugam, Chitra Shanmugam, Manimaran Murugesan, Muthukumaran Kalyansundaram, Sathya Gopalsamy, Amiya Ranjan
Revathy Marimuthu Shanmugam, Chitra Shanmugam, Manimaran Murugesan, Muthukumaran Kalyansundaram, Sathya Gopalsamy, Amiya Ranjan, Department of Medical Gastroenterology, Government Stanley Medical College, Chennai 600001, Tamil Nadu, India
Author contributions: Shanmugam RM and Murugesan M both were involved in management of case and preparation of manuscript; Shanmugam C and Kalyansundaram M were responsible for the revision of the manuscript for important intellectual content and collecting references; Gopalsamy S and Ranjan A both were involved in workup of the case and also helped in preparing the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Amiya Ranjan, MD, Academic Fellow, DM Post Graduate, Department of Medical Gastroenterology, Government Stanley Medical College, No. 1, Old Jail Road, Chennai 600001, Tamil Nadu, India. amiya.gmc@gmail.com
Telephone: +91-9-304360625
Received: May 17, 2019
Peer-review started: May 20, 2019
First decision: August 2, 2019
Revised: August 17, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: November 16, 2019
Processing time: 180 Days and 22.6 Hours
Abstract
BACKGROUND

Oesophageal cancer is the fourth most common cause of cancer-related deaths in India. Esophageal squamous cell carcinomas (ESCCs) arise from the epithelial layer, and commonly present as polypoidal, ulcerative or ulceroproliferative growth in the oesophageal lumen. In contrast, oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme (examples include leiomyoma, fibrovasculoma, lipoma, granular cell tumour or carcinoid), and mostly do not breach the mucosa. Oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme, and mostly do not breach the mucosa. Complete intramural growth of an advanced primary ESCC is an exceedingly rare presentation, with only six cases reported in the literature thus far. We herein report a case of primary ESCC with complete intramural invasion that endoscopically mimics a submucosal lesion.

CASE SUMMARY

A 50 year old male presented with a progressive mechanical type of dysphagia for one month. His history was significant, including squamous cell carcinoma of the tongue that was treated with surgery and chemoradiation 1 year prior. Upper gastrointestinal endoscopy revealed a large, hemispherical lesion with normal-appearing overlying mucosa about 4 cm × 5 cm in size extending from 30-34 cm from incisors. The patient underwent endoscopic ultrasound (EUS), and a fine‑needle biopsy was performed, which was suggestive for squamous cell carcinoma. We herein report a case of primary ESCC with complete intramural invasion, endoscopically mimicking a submucosal lesion. The diagnosis could be established only by a EUS-guided biopsy.

CONCLUSION

This case report highlights that intramural ESCC may look like a submucosal lesion in endoscopy, and EUS biopsy is needed for final diagnosis.

Keywords: Intramural esophageal squamous cell carcinoma; Submucosal lesion of esophagus; Endoscopic ultrasound; Case report

Core tip: A 50 year old male presented with a progressive mechanical type of dysphagia. Upper gastrointestinal endoscopy revealed a large, hemispherical lesion with normal-appearing overlying mucosa. An endoscopic ultrasound (EUS) fine needle biopsy was done. Histopathology was consistent with well-differentiated squamous cell carcinoma. This is to highlight that intramural esophageal squamous cell carcinoma may look like a benign submucosal lesion upon endoscopy, and that a EUS biopsy is needed for final diagnosis.