Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4624
Peer-review started: June 19, 2020
First decision: July 24, 2020
Revised: July 28, 2020
Accepted: September 4, 2020
Article in press: September 4, 2020
Published online: October 6, 2020
Esophageal carcinosarcoma, usually presenting as a pedunculated polypoid mass, is a rare malignancy with coexisting sarcomatoid and carcinomatous components. Its imaging and endoscopic characteristics are similar to those of leiomyosarcoma, liposarcoma and so forth. The diagnosis needs histological confirmation. Surgical resection is the traditional therapy. Endoscopic resection is minimally invasive but still controversial. This paper reports the case of a patient with a giant esophageal carsinosarcoma who underwent a palliative endoscopic resection.
A 55-year-old male patient presented with dysphagia and weight loss for 1 mo. Imaging and endoscopy showed a gray-white, polypoid, stalk-like mass, with a bulky pedicle located in the middle and lower esophagus. The mass almost filled the whole esophageal lumen, but the endoscope could still pass through. Despite the suspicion of a malignancy, repeated biopsies indicated necrosis and inflammation. After multidisciplinary team consultation, an endoscopic resection to diagnose and relieve the obstruction was recommended. The pedicle of the mass was cut off, the bleeding was stopped, and the mass was cut into pieces and pulled out. The mass was 26 cm × 5 cm × 4 cm in size. The final diagnosis was esophageal carcinosarcoma. No postoperative complications occurred. After 1 mo, the patient gained 6 kg and endoscopic reexamination revealed no obstruction. Radical surgery with lymph node dissection was carried out successfully. This lesion was the largest endoscopically resected esophageal carcinosarcoma reported to date.
Endoscopic palliative resection can help obtain adequate tissue for diagnosis and relieve obstructions in patients with giant esophageal carcinosarcoma.
Core Tip: A patient presented with dysphagia and weight loss for 1 mo. Imaging and endoscopy indicated a polypoid stalk-like mass located in the middle and lower esophagus, almost filling the whole esophageal lumen. Repeated biopsies failed to diagnose its nature. An endoscopic palliative resection was performed on this patient, and no postoperative complications occurred. After 1 mo, the patient gained 6 kg and endoscopic reexamination revealed no obstruction. This is the largest endoscopically resected esophageal carcinosarcoma reported to date. Endoscopic palliative resection can help obtain adequate tissue for diagnosis and relieve the obstruction.