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Z Gastroenterol 2025; 63(02): 145-154
DOI: 10.1055/a-2442-9540
Kasuistik

Entirely Intramural Growth Pattern: A Rare Presentation of Esophageal Squamous Cell Carcinoma and Review of the Literature

Vollständig intramurales Wachstumsmuster: eine seltene Darstellung des Plattenepithelkarzinoms der Speiseröhre und Literaturrecherche
Jiayu Qiu‡
1   Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China (Ringgold ID: RIN117970)
,
Yi Tu‡
2   Department of Pathology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (Ringgold ID: RIN117970)
,
Chen Yu‡
3   Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (Ringgold ID: RIN117970)
,
Xu Shu
1   Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China (Ringgold ID: RIN117970)
,
Xiaolin Pan
1   Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China (Ringgold ID: RIN117970)
,
Yanxia Zhang
1   Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China (Ringgold ID: RIN117970)
› InstitutsangabenGefördert durch: Science and Technology Department of Jiangxi Province 20192BAB215034
Gefördert durch: National Natural Science Foundation of China 81401983
Gefördert durch: Scientific Research of Health Commission of Jiangxi Province 202310393
Gefördert durch: Education Department of Jiangxi Province JJ210230
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Abstract

Background

Esophageal squamous cell carcinoma (ESCC) is a malignant tumor originating from the squamous epithelium. In contrast, esophageal submucosal tumors are common benign lesions arising from mesenchymal tissues. To date, an entirely intramural growth of ESCC is very rare. This study described a case of an esophageal submucosal tumor resected by endoscopic submucosal dissection (ESD) that was finally diagnosed as ESCC.

Case report

A 51-year-old woman presented with progressive dysphagia and was provisionally diagnosed with esophageal leiomyoma by further diagnostic modalities. The patient did not have any obvious suspicious malignant features and underwent ESD. However, the histopathology of the resected specimen was reported as poorly differentiated infiltrating squamous cell carcinoma with normal overlying squamous epithelium. Consequently, the patient received additional chemoradiotherapy, and no recurrence was observed during the 2-year follow-up.

Literature review

A comprehensive literature search related to ESCC with entirely intramural growth was performed in PubMed and Embase from their inception up to November 2023, and 12 articles including 13 cases were finally included in the literature review. Subsequently, we extracted information about these cases.

Conclusion

It is concluded that ESCC may masquerade as a submucosal tumor with a complete submucosal growth pattern and is easily misdiagnosed because endoscopic biopsy and iodine staining are always negative. Therefore, if a patient with a submucosal tumor has dysphagia or weight loss in the short term, clinicians should be alert to the possibility of ESCC with a complete submucosal growth pattern. Endoscopic ultrasonography (EUS), chest computed tomography (CT), or positron emission tomography–computed tomography (PET-CT) may help assist in the diagnosis, and EUS-guided fine-needle aspiration (EUS-FNA) could be used to confirm the diagnosis.

Zusammenfassung

Hintergrund

Das Plattenepithelkarzinom der Speiseröhre (ESCC) ist ein bösartiger Tumor, der aus dem Plattenepithel stammt. Im Gegensatz dazu sind submuköse Tumoren der Speiseröhre häufig gutartige Läsionen, die aus mesenchymalen Geweben entstehen. Bis heute ist das vollständig intramurale Wachstum von ESCC sehr selten. In dieser Studie wurde ein Fall eines submukösen Tumors der Speiseröhre beschrieben, der durch endoskopische submuköse Dissektion (ESD) entfernt und schließlich als ESCC diagnostiziert wurde.

Fallbericht

Eine 51-jährige Frau stellte sich mit fortschreitender Dysphagie vor und wurde vorläufig mittels weiterer diagnostischer Verfahren mit einem Ösophagus-Leiomyom diagnostiziert. Die Patientin zeigte keine offensichtlichen verdächtigen malignen Merkmale und unterzog sich einer ESD. Allerdings wurde die Histopathologie des resezierten Präparats als schlecht differenziertes infiltrierendes Plattenepithelkarzinom mit normalem überliegendem Plattenepithel gemeldet. Folglich erhielt die Patientin zusätzliche Chemo- und Strahlentherapie, und während der 2-jährigen Nachbeobachtung wurde kein Rezidiv beobachtet.

Literaturübersicht

Eine umfassende Literaturrecherche zu ESCC mit vollständig intramuralem Wachstum wurde in PubMed und Embase von deren Anfängen bis November 2023 durchgeführt, und 12 Artikel mit 13 Fällen wurden schließlich in die Literaturübersicht aufgenommen. Anschließend extrahierten wir Informationen über diese Fälle.

Schlussfolgerung

Es wird geschlossen, dass ESCC als submuköser Tumor mit einem vollständigen submukösen Wachstumsmuster maskiert sein kann und leicht fehldiagnostiziert wird, da endoskopische Biopsien und Jodfärbungen immer negativ sind. Daher sollten Kliniker bei Patienten mit einem submukösen Tumor, die innerhalb kurzer Zeit Dysphagie oder Gewichtsverlust haben, auf die Möglichkeit eines ESCC mit vollständigem submukösem Wachstumsmuster achten. Die endoskopische Ultraschalluntersuchung (EUS), die Computertomografie des Brustkorbs (CT) oder die Positronen-Emissions-Tomografie-Computertomografie (PET-CT) können bei der Diagnose helfen, und die EUS-gesteuerte Feinnadelaspiration (EUS-FNA) könnte zur Bestätigung der Diagnose verwendet werden.

Keywords

esophageal squamous cell carcinoma - masquerade - mimicking - submucosal tumor - case report - review

Schlüsselwörter

Plattenepithelkarzinom - Maskerade - Nachahmung - submuköser Tumor - Kasuistik - Übersicht


Publikationsverlauf

Eingereicht: 09. Juli 2024

Artikel online veröffentlicht:
25. November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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