A Rare Case of Esophageal Submucosal Angiofibroma Resected Completely by Endoscopic Submucosal Dissection

Abstract

a t a t l p A healthy man experienced the sensation of a lump in his throat, chest tightness, foreign body sensaion, and dysphagia for a half year before presentation. He was reated with antacids without any improvement initially. On xamination, the patient had mild tenderness over the epigasric region. Laboratory studies revealed a normal blood count, ormal biochemistry test results, carcinoembryonic antigen evel, and squamous cell carcinoma level. An esophagogasroduodenoscopy revealed a small bulging mass with intact ucosa (Figure A), estimated to be 5 mm in diameter, in the ower esophagus. A homogenous hypoechoic nodule, measurng 3.2 mm (Figure B), was discovered at the submucosal layer ia endoscopic ultrasound scanning. The overlying muscular ropria and mucosal layer were intact. Endoscopic submucosal issection (ESD) was performed under the impression of esophgeal submucosal tumor. A whitish tumor could be visualized n the deep submucosal layer after circumferential mucosal ncision by using a dual knife. The tumor then was removed ompletely by ESD (Figure C). The specimen was a whiteellowish elastic tumor measuring 5 mm. The pathologic findngs showed the tumor was an angiofibroma of the esophagus. he mitotic count of the tumor was low. The immunostains howed a positive reaction of cytokeratin, vimentin, actin, D34, and Ki67, and the proliferative index was 10% of angiobroma (Figure D). The patient had a good recovery without omplications after ESD. Submucosal tumors of the esophagus are not uncommon nd usually are detected incidentally by routine esophagogasroduodenoscopy examination. To our knowledge, leiomyomas re the most common neoplasm of an esophageal submucosal umor; gastrointestinal stromal tumor, lipoma, hamartoma, ymphangioma, squamous papilloma, and giant fibrovascular olyps are far less common.1 Patients usually are asymptomatic