Giant Esophageal Liposarcoma

Excerpt

A 51-year-old male presented with dizziness, fatigue, and melena, associated with progressively worsening dysphagia and unintentional 35-lb weight loss. A prior esophagogram showed a “Zenker’s diverticulum” by report and a prior esophagogastroduodenoscopy (EGD) mild esophagitis. He was tachycardic, normotensive, but anemic with a hemoglobin level of 5.7 mg/dL. At our institution, a barium esophagogram demonstrated a possible stricture of the cervical esophagus with distal esophageal dilation (Fig. 1a). EGD demonstrated a hard, necrotic 5-cm mass in the cardia of the stomach that appeared to be extending from the esophagogastric junction (EGJ) (Fig. 1b). A computer tomography (CT) showed an esophageal mass involving the length of the esophagus (Fig. 1c). Endoscopic ultrasound (EUS) identified a hypoechoic solid mass lesion extending 20 cm from the incisors down to the EGJ at 40 cm (Fig. 1d). Given these findings and his symptoms, but no definitive diagnosis, an exploratory thoracotomy. Intraoperatively, the esophageal muscle was intact (Fig. 2a). A myotomy was made and the tumor identified. Incisional biopsy with the frozen section was negative for malignancy. The tumor did not involve the muscle. The mass could be easily “shelled out” of the esophagus, thus preserving the esophagus (Fig. 2b). The final pathological diagnosis was a well-differentiated myxoid liposarcoma.

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