Case Report
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World J Gastroenterol. Jun 14, 2014; 20(22): 7055-7060
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.7055
Primary esophageal sclerosing mucoepidermoid carcinoma with “tissue eosinophilia”
Suman Mewa Kinoo, Kapil Maharaj, Bhugwan Singh, Michelle Govender, Pratistadevi Kanaye Ramdial
Suman Mewa Kinoo, Kapil Maharaj, Bhugwan Singh, Department of Surgery, Nelson R Mandela School of Medicine, University of Kwazulu Natal, Durban 4013, South Africa
Michelle Govender, Pratistadevi Kanaye Ramdial, Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, University of Kwazulu Natal and National Health Laboratory Service, Durban 4013, South Africa
Author contributions: All authors contributed equally to this work; The authors from the Department of Surgery provided the clinical features; The authors from the Department of Anatomical Pathology provided the pathological features; all authors contributed equally to the discussion and writing of the manuscript.
Correspondence to: Bhugwan Singh, MD, Professor, Department of Surgery, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, 719 Umbilo Road, Congella 4013, Durban 4013, South Africa. singhb3@ukzn.ac.za
Telephone: +27-31-2604257 Fax: +27-31-2604389
Received: September 10, 2013
Revised: December 5, 2013
Accepted: January 6, 2014
Published online: June 14, 2014
Abstract

Mucoepidermoid carcinoma (MEC) is a rare primary esophageal malignancy. It is characterized by poor clinical recognition, pre-operative diagnostic challenges and a lack of standardized therapeutic guidelines. We report the clinicopathological features of a hitherto unreported variant of esophageal MEC, sclerosing MEC with “tissue eosinophilia”, in a mid-esophageal location in a 51-year-old female. The diagnosis of the initial biopsy was challenging, because of the small size, poor orientation and inadequate representation of the MEC components. Recognition of the resectability of the tumor prompted surgical resection and enabled a demonstration of the low grade foci containing intermediate cells, mucin pools and the hitherto undescribed presence of stromal sclerosis and tissue eosinophils in esophageal MEC. Heightened clinicopathological awareness of esophageal MEC facilitated a definitive diagnosis and patient management. Increased recognition and global documentation of esophageal sclerosing MEC with “tissue eosinophilia” is necessary to improve the understanding and diagnosis of this malignancy in this location and to improve management guidelines.

Keywords: Mucoepidermoid, Carcinoma, Sclerosing, Tissue eosinophilia, Esophagus

Core tip: Primary mucoepidermoid cancer (MEC) of the esophagus, including the sclerosing variant, is rarely reported, and sclerosing MEC with “tissue eosinophilia” has never been reported in this location. The rarity of this latter condition has precluded a thorough understanding of esophageal MEC. Heightened recognition of MEC in this location is also necessary to distinguish MEC from squamous carcinoma, adenocarcinoma or adenosquamous carcinoma. This distinction has therapeutic implications. Based largely on past experience managing tumors in the salivary gland, MEC is characterized by a poor response to adjuvant chemotherapy and radiotherapy; notwithstanding a poor response to surgery, this treatment approach remains the mainstay of management.