PS01.106: PSEUDODIVERTICULOSIS-RELATED ESOPHAGEAL MASS WITH INTENSE FDG UPTAKE

Abstract

Abstract Background Esophageal intramural pseudodiverticulosis (EIPD) is rare condition. The usual symptom is dysphagia mainly due to benign stenosis, and other variety of symptoms and complications have been reported. Only few articles have shown EIPD leading to esophageal mass formation like malignancy. Here, we report EIPD related to esophageal mass with increased up take of 18F-fluorodeoxyglucose followed by esophagectomy. Methods A 48-year-old man presented with dysphagia caused by esophageal stricture. Esophagoscopy showed a protruding submucosal lesion and lumen stenosis in lower third of esophagus. The esophageal mucosa was intact, but one small hole was observed. Positron emission tomography-computed tomography showed the FDG-avid lesion in the lower esophagus. In addition to symptom persistence, possibility of malignancy offered him surgical resection. In the prone position, minimally invasive esophagectomy with gastric tube reconstruction was performed. Results The pathology of the surgical specimen showed that many cystic spaces lined by stratified squamous epithelium were present in the submucosa and partially in the muscularis propria. There was mucosal depression connecting with the cystic spaces, and submucosa was thickened with fibrosis. The dilated spaces formed flask-shaped lesion and intramural tracking parallel to the esophageal lumen. Based on these findings, esophageal intramural pseudodiverticulosis with no evidence of malignancy was diagnosed. The postoperative course was uneventful, and the patient was discharged 18 days after operation. Conclusion EIPD can result in inflammatory mass formation with high up take of FDG and the cavities can protrude into muscularis propria. The present report can be helpful in the assessment of PET-positive tumor. We should consider EIPD in unknown mass in the thoracic esophagus. Early diagnosis followed by conservative therapy may allow adequate control without surgery. The pathogenesis of EIPD remains to be fully clarified, and additional studies will be needed to elucidate the mechanism. Disclosure All authors have declared no conflicts of interest.