Ma XB, Ma HY, Jia XF, Wen FF, Liu CX. Misdiagnosis of an elevated lesion in the esophagus: A case report. World J Clin Cases 2022; 10(27): 9828-9833 [PMID: 36186185 DOI: 10.12998/wjcc.v10.i27.9828]
Corresponding Author of This Article
Cheng-Xia Liu, PhD, Doctor, Professor, Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou 256603, Shandong Province, China. phdlcx@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which 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/
World J Clin Cases. Sep 26, 2022; 10(27): 9828-9833 Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9828
Misdiagnosis of an elevated lesion in the esophagus: A case report
Xing-Bin Ma, Huai-Yuan Ma, Xing-Fang Jia, Fei-Fei Wen, Cheng-Xia Liu
Xing-Bin Ma, Huai-Yuan Ma, Xing-Fang Jia, Cheng-Xia Liu, Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Fei-Fei Wen, Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
Author contributions: Ma XB and Ma HY reviewed the literature and contributed to manuscript drafting; Jia XF was the patient’s EUS and ESD surgeon; Wen FF was involved in pathology evaluation; Liu CX was responsible for revising the manuscript for important intellectual content; all the authors provided final approval for the version of the manuscript to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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 article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Xia Liu, PhD, Doctor, Professor, Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou 256603, Shandong Province, China. phdlcx@163.com
Received: April 20, 2022 Peer-review started: April 20, 2022 First decision: June 19, 2022 Revised: June 30, 2022 Accepted: August 15, 2022 Article in press: August 15, 2022 Published online: September 26, 2022
Abstract
BACKGROUND
Esophageal carcinosarcoma (ECS) is a rare biphasic tumor and a type of esophageal malignancy, which presents as protruding or elevated lesions. ECS patients are often not hospitalized until they have severe dysphagia. ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy. With the popularization of endoscopic treatment, these patients are often referred to endoscopic treatment, such as endoscopic submucosal dissection (ESD). However, there is a lack of consensus on the endoscopic features and therapies for ECS. Here, we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies.
CASE SUMMARY
A 63-year-old man was admitted to the hospital with dysphagia. During the endoscopic examination, an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation. Endoscopic ultrasonography (EUS), biopsies, and enhanced thoracic computed tomography were performed, suggesting that it was a benign lesion and located within the submucosal layer. This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip. The patient was then referred to ESD treatment. However, the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin (T1b stage), indicating that we made a misdiagnosis and achieved a noncurative resection. Due to the potential tumor residue, additional open surgery was performed at the patient's request. In the postoperative pathological study, no tumor remnants or metastases were discovered. The patient was followed for 1 year and had no recurrence.
CONCLUSION
ECS can be misdiagnosed at the initial endoscopy. EUS can help to identify the tumor stage. Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.
Core Tip: Esophageal carcinosarcoma (ECS) is a rare type of esophageal malignancy. ECS commonly presents as a pedunculated characteristic (0-Ip), which is often misdiagnosed due to the lack of specific features. Endoscopic ultrasonography can help to evaluate whether ECS invasion is within the submucosal layer (T1 or T2 stage) but cannot further distinguish whether it is T1a or T1b stage. Due to the high risk of metastasis and recurrence based on the literature review, endoscopic submucosal dissection treatment cannot be routinely recommended for ECS patients with T1b stage disease.
