Endoscopy 2022; 54(11): E619-E621
DOI: 10.1055/a-1724-7162
E-Videos

Endoscopic submucosal dissection of poorly differentiated carcinoma mimicking adenoid-cystic carcinoma of the esophagus

Fabio De Vincentis
1   Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Ravenna, Italy
,
Roberta Maselli
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
3   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Mario Brancaccio
1   Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Ravenna, Italy
,
Alessandro Mussetto
1   Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Ravenna, Italy
› Author Affiliations
 

A 71-year-old man with a history of cryptogenic cirrhosis and hepatocellular carcinoma treated with radiofrequency ablation therapy underwent esophagogastroduodenoscopy (EGD) to evaluate portal hypertension. EGD showed a flat elevated lesion of 15 mm with a mild central depression ([Fig. 1]) and hard consistency on biopsy sampling in the middle esophagus. No esophageal varices were found. The initial histological examination was compatible with adenoid cystic carcinoma with a solid pattern.

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Fig. 1 Esophagogastroduodenoscopy showed a flat elevated lesion of 15 mm with a mild central depression in the middle esophagus.

Adenoid cystic carcinoma is a malignant epithelial tumor arising in the submucosal glands, commonly in the salivary glands and upper respiratory tract. It occurs extremely rarely in the esophagus, where its behavior is biologically aggressive [1]. However, endoscopic ultrasound (EUS) showed a lesion limited to the mucosal layer ([Fig. 2]). Staging was performed with an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan ([Fig. 3]), which showed only uptake in the middle tract of the esophagus.

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Fig. 2 Endoscopic ultrasound showed the lesion was limited to the mucosal layer.
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Fig. 3 Staging of the tumor performed with an 18F-fluorodeoxyglucose positron emission tomography/computed tomography: uptake only in the middle tract of the esophagus (standardized uptake value 3.3)

Owing to the comorbidities, the patient was judged unsuitable for surgery. Therefore, an en bloc resection ([Fig. 4]) was performed by endoscopic submucosal dissection (ESD) ([Video 1]). The definitive histological evaluation showed a poorly differentiated carcinoma with prevalent adenoid-cystic and focal basaloid features ([Fig. 5]). The subsequent multidisciplinary evaluation of the case considered only close radiological and endoscopic follow-up indicated.

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Fig. 4 En bloc resection was performed by endoscopic submucosal dissection.

Video 1 Esophageal endoscopic submucosal dissection. The lesion, initially typified as adenoid-cystic carcinoma, was in fact a poorly differentiated carcinoma.


Quality:
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Fig. 5 Esophageal mucosa with poorly differentiated carcinoma with high proliferative activity (mitotic index: 36 × 10 high-power fields), solid pattern with multiple nodular areas separated by fibrous stroma, with glandular aspects, focal necrosis and areas of stromal hyalinization. a 2 × magnification. b 10 × magnification. c 20 × magnification. d Immunohistochemistry: p40+.

Endoscopic control at 6 months showed the presence of a regular scar at the site of the previous ESD, with no signs of residual or disease recurrence. At the same time, EUS and CT scan ruled out signs of disease recurrence or metastasis.

Endoscopy_UCTN_Code_TTT_1AO_2AG

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Correction

Endoscopic submucosal dissection of poorly differentiated carcinoma mimicking adenoid-cystic carcinoma of the esophagus
De Vincentis F, Maselli R, Brancaccio M. Endoscopic submucosal dissection of poorly differentiated carcinoma mimicking adenoid-cystic carcinoma of the esophagus. Endoscopy 2022, doi:10.1055/a-1724-7162
In the above-mentioned article, the institutions of Roberta Maselli have been corrected. This was corrected in the online version on April 14, 2022.


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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Fabio De Vincentis, MD
Gastroenterology Unit
Santa Maria delle Croci Hospital
Viale Vincenzo Randi, 5
48121 Ravenna
Italy   

Publication History

Article published online:
26 January 2022

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Zoom Image
Fig. 1 Esophagogastroduodenoscopy showed a flat elevated lesion of 15 mm with a mild central depression in the middle esophagus.
Zoom Image
Fig. 2 Endoscopic ultrasound showed the lesion was limited to the mucosal layer.
Zoom Image
Fig. 3 Staging of the tumor performed with an 18F-fluorodeoxyglucose positron emission tomography/computed tomography: uptake only in the middle tract of the esophagus (standardized uptake value 3.3)
Zoom Image
Fig. 4 En bloc resection was performed by endoscopic submucosal dissection.
Zoom Image
Fig. 5 Esophageal mucosa with poorly differentiated carcinoma with high proliferative activity (mitotic index: 36 × 10 high-power fields), solid pattern with multiple nodular areas separated by fibrous stroma, with glandular aspects, focal necrosis and areas of stromal hyalinization. a 2 × magnification. b 10 × magnification. c 20 × magnification. d Immunohistochemistry: p40+.