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CC BY 4.0 · Endoscopy 2024; 56(S 01): E396-E397
DOI: 10.1055/a-2307-6213
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Snare traction-assisted endoscopic submucosal dissection for removal of rare giant laryngeal liposarcoma

Authors

  • Rui Zhao 

    1   Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China (Ringgold ID: RIN34753)
    2   Department of Endoscopy, Sichuan Cancer Hospital and Institute, Chengdu, China (Ringgold ID: RIN92293)

  • Jiaxin Yan

    3   Department of Pathology, Sichuan Cancer Hospital and Institute, Chengdu, China (Ringgold ID: RIN92293)

  • Ye-Han Zhou

    3   Department of Pathology, Sichuan Cancer Hospital and Institute, Chengdu, China (Ringgold ID: RIN92293)

  • Yu Bao

    2   Department of Endoscopy, Sichuan Cancer Hospital and Institute, Chengdu, China (Ringgold ID: RIN92293)

  • Yan Zhang 

    1   Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China (Ringgold ID: RIN34753)
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A 78-year-old man presented with a foreign body sensation in the throat for 1 year. Endoscopy revealed a large pedunculated tumor in the throat, extending deep into the mid-thoracic esophagus ([Fig. 1]). Computed tomography (CT) of the throat showed a column-like region with a density similar to fat located within the larynx and esophageal entrance to the mid-thoracic lumen, without significant contrast enhancement ([Fig. 2]).

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Fig. 1 Endoscopic findings. a Tumor in the larynx. b Esophageal entrance. c Mid-esophagus. d Snare traction.
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Fig. 2 Computed tomography showing column-like region with a fat-like density in the larynx, without significant contrast enhancement.

We performed endoscopic submucosal dissection (ESD) using a snare to expose and retract the base of the lesion ([Video 1]). The entire operation lasted 53 min. The tumor was removed through the mouth using the snare ([Fig. 3]). No adverse events or complications were observed.

Endoscopic submucosal dissection (ESD) was performed to remove a giant laryngeal liposarcoma.Video 1

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Fig. 3 The specimen measured 16.5 cm in length and 2.7 cm in width at its widest point.

Histological analysis revealed a well-differentiated liposarcoma. Furthermore, fluorescence in situ hybridization demonstrated significant MDM2 gene amplification ([Fig. 4]).

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Fig. 4 Histological analysis revealed a well-differentiated liposarcoma. a Hematoxylin and eosin-stained images (× 40). b–e The tumor cells were S100(+) (b), CDK4(+) (c), P16(+) (d), and MDM2(+) (e). f Fluorescence in situ hybridization showed that 67% of cells had an amplification of MDM2 copy numbers.

Well-differentiated liposarcomas are frequently encountered in the esophagus and hypopharynx [1], with rare occurrences in the larynx. While previous reports have described the removal of liposarcomas from the hypopharynx using ESD or surgical resection [2] [3], the excision of laryngeal liposarcomas using ESD has not been reported. Here we present the first reported case of complete excision of a laryngeal liposarcoma using ESD.

The management of large neoplasms can be improved with the use of a snare for applying effective traction. However, its application for the treatment of giant tumors in the larynx has not been documented. In the confined pharyngeal and laryngeal spaces, intraoperative snare-assisted traction of the lesion aids in generating adequate space and offering a clear view, thus enabling complete tumor excision at the basal cut margin. This case demonstrates the efficacy of snare traction-assisted ESD as a minimally invasive, safe, and feasible treatment method for large pedunculated laryngeal tumors. Regular postoperative follow-up is necessary to monitor for local recurrence.

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Yan Zhang, MD
Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University
No. 37 Guo Xue Alley, Wuhou District
Chengdu, Sichuan Province
China   

Publication History

Article published online:
07 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Endoscopic findings. a Tumor in the larynx. b Esophageal entrance. c Mid-esophagus. d Snare traction.
Zoom
Fig. 2 Computed tomography showing column-like region with a fat-like density in the larynx, without significant contrast enhancement.
Zoom
Fig. 3 The specimen measured 16.5 cm in length and 2.7 cm in width at its widest point.
Zoom
Fig. 4 Histological analysis revealed a well-differentiated liposarcoma. a Hematoxylin and eosin-stained images (× 40). b–e The tumor cells were S100(+) (b), CDK4(+) (c), P16(+) (d), and MDM2(+) (e). f Fluorescence in situ hybridization showed that 67% of cells had an amplification of MDM2 copy numbers.