Esophageal Mass Research Articles

Esophageal Verrucous Carcinoma: A Case Report and Review of a Rare Disease

Purpose: A 64-year-old male presented with progressive dysphagia to solids and liquids and associated unintentional weight loss. EGD revealed an exophytic, circumferential mass in the distal esophagus extending through the GE junction involving the gastric cardia (Figure 1A). Biopsies from the mass showed a squamous papilloma with parakeratosis and reactive cytological atypia. EUS demonstrated the mass to be transmural, invading through the serosa and abutting the left pleura (Figure 1B). Suspicious lymphadenopathy was noted in the subcarinal, paraesophageal, and celiac regions. Cytology from FNA of subcarinal nodes returned with insufficient tissue. The mass was intensely FDG-avid on PET-CT scan. Because of significant concerns for malignancy despite biopsy results, the patient underwent a transhiatal esophagectomy, mediastinal and abdominal lymphadenectomy, and creation of a cervical esophagogastrostomy. Operative pathology returned consistent with invasive, well-differentiated squamous cell carcinoma involving the distal esophagus and proximal stomach invading through the muscularis propria into the adventitia. All 34 lymph nodes sampled were negative for metastatic disease. Surgical margins were negative. Final staging was T3N0. The patient has had no evidence of disease recurrence in follow-up over the past year. Esophageal verrucous carcinoma (EVC) is an extremely rare variant of squamous cell carcinoma with few cases reported in the literature since initially being described in 1967. As in our case, a history of tobacco and alcohol use is often obtained. The association between EVC and human papilloma virus is not firmly established. Most commonly, EVC has a wart-like, exophytic appearance with white coloration. Concomitant Candida esophagitis is frequently seen. EVC presents a diagnostic dilemma as routine mucosal biopsies are typically negative for carcinoma despite the endoscopic appearance of malignancy. EVC tends to spread superficially and grow slowly with low rates of metastasis even in patients with prolonged symptomatology. Care must be taken to avoid over-staging by EUS, which can occur due to associated adjacent inflammatory changes, so as to not preclude curative surgical resection as the treatment of choice for EVC.Figure

Dysarthria as the Initial Manifestation of Esophageal Adenocarcinoma

Purpose: The majority of patients with esophageal cancer typically present with dysphagia, weight loss, and/or odynophagia at the time of diagnosis. Half of all newly diagnosed cases are unresectable or have distant metastasis with involvement of the lungs, liver, and/or adrenal glands. Brain metastases from esophageal carcinoma are very rare. In the available literature, the incidence of brain metastasis has been shown to be at 0-2% in clinical studies and 0-5.1% in autopsy studies. We report a case of a 65-year-old Caucasian man presenting with a 7-day history of progressive dysarthria. He denied any other complaint and had no other physical exam findings. The patient did admit to using chewing tobacco on and off for the past 20 years. His medical history was positive for being treated for prostate cancer 4 years prior with radiation. The initial head computed tomography (CT) demonstrated a left frontal lobe mass measuring 25 mm with metastatic characteristics (Figure 1). A wide search for a primary source of the cancer was undertaken and a dilated distal esophagus just proximal to the gastroesophageal junction with wall thickening was noted on CT scan. Endoscopy demonstrated a circumferential distal esophageal ulcerated mass extending 5 cm to the proximal part of the stomach. Biopsy of the mass proved to be positive for moderately differentiated invasive adenocarcinoma which was Gastric HER-2 NEU positive. Due to the rare occurrence of brain metastasis from esophageal cancer and given the history of previously treated prostate cancer the patient underwent a brain biopsy which also confirmed metastatic adenocarcinoma. The lesion was unable to be completely resected due to worsening dysarthria during the procedure. Despite the low incidence of brain metastasis from esophageal cancer, when other more common sources are excluded, one must keep esophageal carcinoma as a possible primary lesion.Figure

Direct Endoscopic Mediastinal Necrosectomy

Figure: No Caption available.Purpose: The patient is a 68-year-old male with stage IV non-small cell lung cancer who presented with a 3-month history of progressive solid food dysphagia. Initial evaluation included a chest CT that showed an increase in subcarinal lymphadenopathy, a decrease in the left lower lobe adenocarcinoma and an EGD that showed a 5-cm midesophageal stricture secondary to extrinsic compression. Palliative radiation therapy was administered to the subcarinal area. Two months later, the patient presented with productive cough and fevers. Chest CT revealed progression of disease and a 7.5-cm walled-off necrotic mass with air and fluid levels in the posterior mediastinum. Per the patient's and his family's wishes, the patient was hospitalized for the abscess management with IV antibiotics and endoscopic therapy. Methods: A diagnostic upper endoscope was inserted into the esophagus and a completely obstructing mass was encountered in the proximal esophagus. Mechanical debridement with a spiral snare was initiated and repeated multiple times. The continued debridement allowed for visualization of the second obstructing mass located at the gastroesophageal junction and a fistulous tract from the esophagus into the mediastinum. The endoscope was driven into the necrotic cavity through the fistulous tract. The same maneuvers used for debridement of the esophageal mass were again used for the debridement of infected walled-off mediastinal necrosis. A partially covered self-expandable stent was then deployed under direct fluoroscopic visualization across the first obstructing mass and fistula; contrast injected showed no leak. A second, bridging, partially covered self-expandable stent was then deployed to traverse a second tumor obstruction. Results: An esophogram on post-procedure day one showed good position of the overlapping stents without contrast extravasation. Conclusion: Direct endoscopic necrosectomy is most commonly used for debridement of walled-off pancreatic necrosis with good results. When possible, and in the right clinical setting, mediastinal direct endoscopic necrosectomy can be safely performed. This treatment modality is potentially a feasible therapeutic alternative to thoracoscopic or open surgical therapy in a right clinical setting. However, experience and published data are limited.

Verrucous Squamous Cell Carcinoma of the Esophagus Presenting as a Tracheo-esophageal (T-E) Fistula

Purpose: A 53-year-old African-American woman with a history of hypertension, asthma, and gastroesophageal reflux disease (GERD) was admitted for 3 days of progressive dyspnea. She first noted GERD symptoms 7 years prior. An esophagogastroduodenoscopy (EGD) at that time revealed an esophageal mass that was biopsied and found to be benign. For the last 2 months, she noted worsening heartburn and regurgitation associated with productive cough and wheezing. She denied fever, chills, or sick contacts. Pleuritic chest pain and severe dyspnea prompted admission. On exam she was a thin tachypneic woman. She was afebrile, saturating 97% on room air. She had clubbing, supraclavicular retractions, bilateral wheezing, and rales. Lab tests revealed normal hemoglobin (12 g/dL) and an elevated white count (15,000) with 91% neutrophils. Computed tomography (CT) showed bilateral lower lobe consolidation, ground glass opacities, and nodular mural thickening of the mid-distal esophagus distended with debris. The impression was aspiration pneumonia with possible achalasia/pseudoachalasia. The patient was treated with antibiotics and an endoscopy was planned. On EGD, a necrotic mass covered with slough was seen in the esophagus extending 30-36 cm from the incisors. There was a diverticulum in the distal esophagus close to the Z-line. Biopsies revealed hyperkeratosis with no features of malignancy. She was placed on esomeprazole 40 mg twice a day and discharged with plans for follow-up with endoscopic ultrasound when her respiratory status improved. One month later she was readmitted with aspiration pneumonia and acute dyspnea. EGD for gastrostomy placement was done after strict NPO. At this time T-E fistula was suggested. A coronal re-evaluation of the CT scan confirmed the mural thickening of the mid-distal esophagus connected to the tracheal carina. Repeat EGD for stent placement showed a large fistula 35 cm from the incisors and distal to it a stricture. A 23 mm to 15 cm-long covered metal stent was placed. Despite excellent positioning, the patient continued to aspirate. She was transferred to a tertiary institution. Bronchoscopy also revealed an erosive mass. A fistula of the left bronchus was noted, requiring two endobronchial stents. Tracheal biopsy of the mass was negative for malignancy. Due to the high suspicion, the patient underwent open lung biopsy. This revealed an epithelial verrucous squamous cell carcinoma. It is a rare well-differentiated squamous carcinoma that divides slowly, invades locally, and metastasizes rarely. Diagnosis requires deep biopsies and a high index of suspicion.

Inflammatory myofibroblastic tumor in the esophagus after treatment for superficial esophageal cancer

A 76-year-old man was referred to our hospital for treatment of a submucosal tumor in the esophagus. The patient had a history of superficial esophageal cancer treated by endoscopic resection and radiation. Positron emission tomography showed intense localized uptake of fluorodeoxyglucose on the esophageal mass. Transthoracic esophagectomy and reconstruction with a gastric tube were performed. Histopathological examination revealed that the tumor consisted of a proliferation of atypical spindle cells with infiltration of many inflammatory cells. The spindle cells were positive for vimentin, alpha smooth muscle actin, and anaplastic lymphoma kinase immunostaining. The Ki-67 labeling index was 10–20 %. The tumor was finally diagnosed as inflammatory myofibroblastic tumor. Late phase inflammation caused by radiation potentially had an effect on the occurrence of the tumor in this case. For tumors of the irradiated esophagus, especially, careful pretreatment examination and treatment strategies with consideration of the radiation damage are important to obtaining a favorable outcome.

Severe Dysphagia, Candidiasis, and an Oesophageal Mass, but Over 50 Biopsies Negative for Malignancy

Severe Dysphagia, Candidiasis, and an Oesophageal Mass, but Over 50 Biopsies Negative for Malignancy

PTU-139 An Unusual Complication of Myelodysplasia

IntroductionOesophageal haematoma is a rare clinical entity which is part of the spectrum of oesophageal injuries that includes Mallory-Weiss tear and Boerhave’s syndrome. We present a case of oesophageal haematoma...

Semiquantitative histologic evaluation improves diagnosis of esophageal carcinoma cuniculatum on biopsy

Carcinoma cuniculatum, a unique variant of well-differentiated squamous cell carcinoma, has been only rarely reported in the esophagus. The present study was undertaken to determine if a previously observed common histologic pattern for carcinoma cuniculatum is diagnostically useful in esophageal mucosal biopsy specimens. Thirty-five esophageal mucosal biopsies obtained from 25 procedures in 11 patients with a resection-proven diagnosis of carcinoma cuniculatum were compared with 92 esophageal biopsies from 69 patients with benign diagnoses. All biopsies were assessed for the presence of hyperkeratosis, acanthosis, dyskeratosis, deep keratinization, intraepithelial neutrophils, neutrophilic microabscess, focal cytologic atypia, koilocyte-like cells, and keratin-filled cyst/burrows. Each feature, if present, was given one point, and the final histologic score was calculated for each biopsy by summing the points. The mean histologic score was 6.66 (s.d. 1.88) in biopsies from carcinoma cuniculatum vs a mean score of 1.93 (s.d. 1.75) for biopsies with benign diagnoses (P<0.0001). Using a cutoff value of 7 for carcinoma cuniculatum, 57% of biopsies (20/35) from 64% esophagogastroduodenoscopy procedures (16/25) in 91% patients (10/11) would be diagnostic, in comparison to the initial diagnostic rates of carcinoma of 9, 12, and 27%, respectively (P<0.0001 for all). None of the 92 benign biopsies showed a score of ≥7. Our results demonstrate that a semiquantitative histologic evaluation of mucosal biopsies taken from an esophageal mass greatly improves the diagnostic sensitivity from patients with carcinoma cuniculatum with 100% specificity. Larger studies are necessary to confirm the current findings.

Bizarre Stromal Cells in the Esophagus

A significant mimicker of malignancy in the esophagus is the presence of atypical/bizarre stromal cells (BSCs). Two patients, a 60-year-old woman and a 59-year-old man, with esophageal polyps at the gastroesophageal junction showed highly atypical/bizarre cells in the polyps' stroma. BSCs were admixed with inflammatory cells and had large atypical nuclei, prominent nucleoli, and variably abundant amphophilic cytoplasm. Immunohistochemical studies showed that BSCs expressed vimentin whereas S-100, CD68, HMB45, CD45, Pan-cytokeratin, CK5/6, p63, CD10, EMA, MART-1, desmin, smooth muscle actin, CD31, CD34, and CMV were negative. Ki-67 showed low proliferative rate (less than 1% positivity). No evidence of intracellular mucin was found after histochemical stains (AB/PAS and mucicarmine). Follow-up endoscopic mucosal resection was available in both cases and showed benign esophageal mucosa and submucosa with disappearance, in one case, or marked decrease of BSCs. Esophageal BSCs reports in the literature invariably locate them in distal esophagus polyps or masses. Awareness of BSCs, of their location and associations, may help to prevent misdiagnosis of malignancy. The literature of esophageal BSCs is reviewed and the approach to this abnormality is discussed.

Successful transendoscopic oesophageal mass ablation in two dogs with Spirocerca lupi associated oesophageal sarcoma

This report describes two cases of oesophageal tumours managed by transendoscopic neodymium:yttrium-aluminum-garnet laser ablation and polypectomy snare electrocautery. In each dog oesophagoscopy revealed caudal oesophageal masses, suspected to be Spirocerca lupi-induced oesophageal neoplasia. To resect the masses, transendoscopic neodymium:yttrium-aluminum-garnet laser ablation was used in the first case and polypectomy snare electrocautery in the second. Recovery was uneventful. Histopathology was consistent with oesophageal fibrosarcoma and osteosarcoma in each case, respectively. Follow-up oesophagoscopy revealed apparently healthy oesophageal tissue except for focal scar tissue in the first case. Transendoscopic laser ablation and polypectomy snare electrocautery is a potential non-invasive, cost effective alternative for surgical oesophageal mass resection.

Intramural hematoma of the esophagus in a woman with chronic renal failure and prophylactic heparin therapy

CASE REPORT An 86 year-old woman experienced chest pain, dyspnea, and dysphagia two days following orthopaedic surgery for a bimalleolus fracture of the right ankle. The patient was on prophylactic low weight molecular heparin and was affected by chronic renal failure. The chest computed tomography (CT) ruled out a pulmonary embolism but showed an intramural esophageal mass involving the entire esophagus. The lesion exhibited a blood like CT attenuation content that did not enhance after contrast administration. The esophagogram with gastrografin did not reveal filling defects nor communications between lumen and mucosa. Magnetic resonance confirmed CT results and excluded an aortic dissection. All radiological findings were suggestive of intramural hematoma of the esophagus. DISCUSSION AND CONCLUSIONS Intramural hematoma of the esophagus (IHE) is part of the spectrum of esophageal injuries that includes Mallory-Weiss tear and Boerhaave’s syndrome. IHE is the result of a hemorrhage within the submucosal layer. Predisposing conditions are abnormal hemostasis, traumatic events, aortic diseases. It can also occur spontaneously (idiopathic). Treatment should be conservative and includes risk factors withdrawal. The hematoma usually resolves in 1 to 3 weeks.

Abstract 1373: Clinical and economic burden of incidental findings suspicious for cancer on non-contrast chest computed tomography performed during myocardial perfusion imaging.

Abstract Background: Radionuclide myocardial imaging is often performed to rule out cardiac ischemia. One drawback is that tissue like breast or stomach can result in attenuation artifact. A common practice involves obtaining a non-contrast low resolution attenuation corrected chest CT (ACCT). No studies have evaluated the clinical &amp; economic burden of findings suggestive for lung cancer on these ACCT images. Methods: Consecutive patients undergoing ACCT from Jan 2005 - Dec 2008 were enrolled. Clinically significant findings were defined as those requiring further follow-up or clearly having features suspicious for lung cancer. For non- calcified lung nodules, our size cutoff was &amp;gt;4 mm in smokers &amp; &amp;gt;6 mm in non-smokers. Follow-up &amp; economic data were obtained from review of hospital &amp; claims records respectively. Mortality data were obtained by social security death index. Direct costs were calculated from procedure related costs &amp; health care utilization costs. Results: Of 1139 patients that underwent ACCT (mean age 59.6 ± 11.3 years, women 47%), 1088 had a median follow up of 4 years. We found 62 patients with lung nodules, 1 with consolidation, 11 with pleural effusion, 5 with pleural plaques, 1 with esophageal mass, 2 with breast masses, &amp; 5 with lymphadenopathy. Of these, a total of 15 patients were confirmed to have lung cancer, 1 with esophageal cancer, 1 breast cancer, &amp; 1 lymphoma, 6 of whom suffered cancer related death. Of the 1001 patients without any clinically significant findings in whom follow up was available, 22 were later discovered to have a new cancer diagnosis localized to the chest within the field of vision of ACCT. Of the 22 patients with cancer, 6 died from their cancer related process, an overall proportion of 0.6%, markedly less than in those with clinically relevant findings (7%) on ACCT (chi2 = 28.3, p &amp;lt;0.0001). In the 85 patients with clinically significant findings, a total of 166 diagnostic procedures (including bronchoscopy, CT guided biopsy, transbronchial biopsy) &amp; additional imaging tests were performed to identify the suspicious lesions. Also, these patients logged a total of 49 ED/inpatient visits &amp; 64 outpatient visits prior to confirmatory pathological diagnosis. The mean direct cost of investigating a suspicious lesion that was found to be malignant was $78,630 (rate current to June 2012). The mean direct cost incurred until death due to cancer in patients with clinically significant findings was $341,200 vs. $181,000 (p &amp;lt;0.0001) in patients that died from cancer located in the chest area that did not initially have a clinically significant finding. Conclusion: This study is the first of its kind to characterize the clinical &amp; economic burden of suspicious incidental findings on ACCT. Despite additional economic burden, patients with clinically significant incidental findings had a higher mortality rate. Citation Format: Zaid Alirhayim, Fatima Khalid, Abdulqader Alarhayem, Syed Hassan, Sophia Qureshi, Waqas Qureshi. Clinical and economic burden of incidental findings suspicious for cancer on non-contrast chest computed tomography performed during myocardial perfusion imaging. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1373. doi:10.1158/1538-7445.AM2013-1373

COMPUTED TOMOGRAPHIC AND RADIOGRAPHIC CHARACTERISTICS OF AORTIC LESIONS IN 42 DOGS WITH SPIROCERCOSIS

Spirocerca lupi is a common cause of vomiting, regurgitation, and sudden death in dogs that live in tropical or subtropical regions. Sudden death due to aortic rupture may occur with no preceding clinical signs. The purpose of this prospective study was to compare radiographic and computed tomographic (CT) characteristics of aortic lesions in a cohort of 42 dogs with endoscopically confirmed spirocercosis. Dorsoventral and right lateral recumbent thoracic radiographic findings were compared with pre- and postcontrast thoracic CT findings. Aortic mineralization was detected using CT in 18/42 dogs (43%). Three dogs had faint diffuse aortic wall mineralization. Using CT as the reference standard, radiographs had a sensitivity and specificity of 6% and 96%, respectively, for detecting aortic mineralization. A total of 20 aortic aneurysms were detected using CT in 15/42 dogs (36%). Using CT as the reference standard, radiographs had a sensitivity and specificity of 86% and 56%, respectively, for detecting aortic aneurysms. Respiratory motion, aortic displacement by esophageal masses and Spirocerca nodules adjacent to the aorta mimicked aneurysm formation on radiographs. Aortic thrombi were seen in two dogs in postcontrast CT images. Findings from this study indicated that aortic mineralization and aneurysm formation are common in dogs with spirocercosis. Findings also supported the use of pre- and postcontrast CT as effective methods for detecting and characterizing these lesions.

Robotic‐assisted enucleation of a large lower esophageal leiomyoma and review of literature

Leiomyoma is the most common benign esophageal neoplasm. Different invasive surgical approaches have been described for management of such lesions. The literature is reviewed and a robotic assisted left thoracoscopic enucleation with the patient in the right side position is described. A 40-year-old male patient, otherwise healthy, found to have a lower midiastinal mass on screening X-ray, is described. Physical examination and blood tests were within normal limits. Diagnostic work-up included: computerized tomography (CT) scanning of the chest and midiastinum that revealed a 40 × 30 mm mass of the distal esophagus, an upper gastrointestinal endoscopy showed a lower protruding esophageal submucosal mass with intact mucosa, a filling defect was apparent on esophagography. Endoscopic ultrasonography (EUS) showed the same findings, biopsies were taken and leimyoma was diagnosed. Under general anesthesia with a double-lumen endotracheal tube, the patient was positioned on his right side. A 30 robotic scope was introduced in the left 7th intercostal space on the posterior axillary line. Two 8-mm robotic trocars were inserted in the left 5th and 9th intercostals spaces on the same line. Operative field was clearly exposed and an additional 5-mm ethicon trocar was inserted. The inferior pulmonary ligament was released, the parietal pleural space opened, proximal and distal control was achieved using Penrose. The muscular layer of the lower esophagus was opened by coagulation hook, the lesion was enucleated without mucosal penetration. Intraoperative endoscopy permitted localization of the lesion and ensured mucosal integrity. The muscular layer was not closed and the chest drain was left. Total operative time was 200 min and blood loss was less than 20 mL. A Gastrograffin swallow on the first post-operative day showed good esophageal clearance and absence of leak, the patient was allowed a liquid diet. He was discharged on the third post-operative day in a good general condition, benign pathology was confirmed.

Primary Mucosa-associated Lymphoid Tissue Lymphoma of the Esophagus, Manifesting as a Submucosal Tumor

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type.

A Rare Case of Malignant Glomus Tumor of the Esophagus

Glomus tumors are rare neoplasms that usually occur on the hands in a subungual location, or sometimes in palms, wrists or soles of the feet. They are described as purple/pink tiny painful lesions with a triad of pain, local point tenderness, and cold hypersensitivity. They are almost always benign, but rare malignant variants have been reported. They have also been reported to be present at unusual locations, like the lung, stomach, or liver. Gastrointestinal glomus tumors are extremely rare tumors and very few cases have been reported in the literature. Most that have been reported were usually benign in nature. A rare esophageal glomangioma, mimicking a papilloma, was reported in 2006. We report a case of glomangiosarcoma (malignant glomus tumor) in a 49-year-old female, who presented with symptoms of dysphagia including some spasm and hoarseness and subjective unintentional weight loss. On endoscopic exam, she was found to have a distal esophageal mass with malignant features. Radiologically, the mass had a size of about 8 cm on the CT scan without evidence of metastases. Pathology and immunostaining of the biopsy showed features resembling a malignant glomus tumor. She underwent an endoscopic and laparoscopic staging of the tumor along with ultrasound. Based on the laparoscopic findings, which were consistent with the preoperative diagnosis, she was scheduled for an esophagectomy. Histopathology and immunophenotypic features of the excised mass were consistent with a diagnosis of malignant glomus tumor.

Esophageal mucosal metastasis from adenocarcinoma of the distal stomach

Dissemination of gastric cancer may usually occur by direct spread through the perigastric tissues to adjacent organ, lymphatic spread, and hematogenous spread. We report a rare case of gastric cancer with mucosal metastastic lesion on the upper esophagus that was diagnosed by endoscopy and endosonography. A biopsy of the esophageal mass was performed and the pathologic findings with immunohistochemical stain for Mucin-5AC are proved to be identical to that of gastric adenocarcinoma, suggesting metastasis from main lesion of the gastric cancer. The lesion could not be explained by lymphatic or hematogenous spread, and its metastasis mechanism is considered to be different from previous studies. We suggest that the gastroesophageal reflux of cancer cells could be one of the possible metastatic pathways for metastasis of esophagus from an adenocarcinoma of the stomach.

Persistent Regurgitation in Four Dogs with Caudal Esophageal Neoplasia

Esophageal neoplasia is an uncommon, but important, consideration for acute and chronic regurgitation and megaesophagus in dogs. The diagnosis can be challenging, and treatment options are often limited. This case series describes four dogs with regurgitation secondary to caudal esophageal masses. All dogs presented with regurgitation, and three of the four dogs had radiographically apparent megaesophagus. In all dogs, ancillary diagnostics revealed the presence of a caudal esophageal mass resulting in esophageal obstruction, and all mass lesions were histopathologically confirmed to be neoplastic. Treatment responses were variable, with one dog still alive 37 mo postdiagnosis at the time of manuscript preparation.

Spirocerca lupi-associated vertebral changes: A radiologic-pathologic study

Spirocerca lupi causes a caudal esophageal mass in dogs which may be accompanied by aortic changes and caudal thoracic spondylitis. Previous literature hypothesized that the spondylitis was caused by either aberrant larval migration or was secondary to the inflammation caused by the aortic migration. The current study aimed to evaluate these hypotheses. Ten dogs of various breeds and ages with radiographic evidence of spondylitis, which were necropsied, had the affected vertebrae removed and prepared for light and transmission electron microscopy examination. Transverse and sagittal sections of the ventral vertebrae were taken from 27 spondylitis and 8 spondylosis deformans lesions as well as from 8 normal vertebrae. Early spondylitis changes were characterized by periosteal woven new bone covered by hyperplastic periosteum with some involvement of the ventral longitudinal ligament. More mature lesions were characterized by nodules of denser trabecular bone and cartilage, also covered by hyperplastic periosteum and involved the ventral longitudinal ligament. It was difficult to distinguish the spondylitis and spondylosis deformans new bone. Inflammation was seen in five spondylitis cases (edema, lymphocytes, plasma cells, eosinophils and fibrin fibers). Spirocerca eggs were seen in one histologic section. This study shows that inflammation is mild and inconsistent in spirocercosis-induced spondylitis and that aberrant migration of the larvae or adults did not appear to be a predominant cause. Inflammatory mediators or osteoproliferative growth factors, which may be related to the primary esophageal lesion or to the worm itself, could be involved. This requires further investigation.

Transoral Endoscopic Resection of Esophageal Liposarcoma

A 63-year-old man presented with a 1-month history of dysphagia. Endoscopy showed the patient had a mass in the cervical esophagus. Multiple biopsy specimens were taken, which were inconclusive for a diagnosis. A positron-emission tomography scan showed a hypermetabolic lesion. A transoral endoscopic approach was used to resect the tumor. Final histologic examination revealed a completely resected low-grade liposarcoma.