Submucosal gland neoplasms of the esophagus: an update and review

Clinical, endoscopic and histopathological observation of a rare case of esophageal submucosal gland duct adenoma: A case report

BACKGROUND

Esophageal submucosal gland duct adenoma (ESGDA) is very rare, and easily diagnosed as adenocarcinoma.

CASE SUMMARY

A 70-year-old man presented with abdominal discomfort and intermittent dull pain during swallowing for 10 days. Digestive endoscopy revealed a polypoid bulge at the esophago-gastric junction, which was resected by endoscopic submucosal dissection (ESD). Routine pathological examination showed intestinal metaplasia of the glandular epithelium on the mucosal surface, with serous tumor-like complex glands in the submucosa which showing significant hyperplasia. This initially diagnosis was early gastric adenocarcinoma. However, we still observed a few points that did not meet the criteria for cancer such as lack of malignant features. Following multidisciplinary discussion and consultation with the experienced specialist pathologists, we finally diagnosed the lesion as a rare ESGDA by further immunohistochemistry. The follow-up examination results for the patient were satisfactory, with no evidence of tumor recurrence. And we summarize the ESGDAs reported in the literature, aiming to enhance understanding of this tumor type.

CONCLUSION

ESGDA is a benign tumor that can be cured by ESD. Accurate diagnosis can prevent unnecessary extensive therapeutic interventions.

Case report: Detection and treatment of a rare submucosal gland duct adenoma of the esophagus

This article reports a rare case of esophageal submucosal gland duct adenoma (ESGDA). The patient was found to have this tumor after undergoing endoscopy in an outpatient clinic due to occasional tingling while eating. White light endoscopy revealed the tumor as a dumbbell-shaped bulge, and ultrasound endoscopy revealed it as a hypoechoic mass located in the submucosal layer. The tumor was successfully resected by endoscopic mucosal dissection with no postoperative recurrence and a good prognosis. In conjunction with literature analysis, the diagnosis of ESGDA relies mainly on endoscopic and pathologic examinations, and its histologic features are highly specific. Despite the rarity of ESGDA, accurate histologic evaluation is essential to avoid misdiagnosis. Complete endoscopic resection is an effective treatment with a favorable long-term prognosis. Further studies remain necessary to reveal its pathogenesis.

Submucosal gland differentiation and implications in esophageal basaloid squamous cell carcinomas

Esophageal basaloid squamous cell carcinoma (BSCC) is a heterogenous entity with multilineage differentiation. It lacks systematical analysis on submucosal gland differentiation (SGD) due to the histological diversity and low incidence of esophageal BSCC. This study aims to find the correlation of SGD and clinicopathological features. A total of 152 esophageal BSCCs were separated into three histological groups: pure, mixed, and borderline group. The clinicopathological features were compared between different groups. The prevalence of SGD was also compared between cases of different groups. A panel of antibodies were used to identify SGD. The pure group differed from the mixed and borderline groups in many aspects, lymph node metastasis (LNM), cancer embolus, perineural invasion, and advanced stage occurred less frequently in the pure group (P<0.01). The pure group had a better but statistically insignificant overall survival (P=0.097). The squamous cell carcinoma (SCC) component or focal squamous differentiation was present in metastatic lymph nodes in almost all mixed BSCCs (95.7%, 22/23) with LNM. The LNM rate of superficial (T1b) BSCCs (17.6%, 6/34) was comparable to that of superficial (T1b) SCCs (18.5%, 57/308). However, LNM exclusively occurred in superficial mixed (3/5) and borderline (3/10) BSCCs. The IHC results demonstrated a prevalence of SGD in pure group (77%, 43/56). SGD is considered to be a favorable factor, while the squamous differentiation or invasive SCC component is an adverse factor in esophageal BSCCs. Refinement of classification is a promising way to improve patient management.

Key Stress Response Mechanisms of Probiotics During Their Journey Through the Digestive System: A Review

The survival of probiotic microorganisms during their exposure to harsh environments plays a critical role in the fulfillment of their functional properties. In particular, transit through the human gastrointestinal tract (GIT) is considered one of the most challenging habitats that probiotics must endure, because of the particularly stressful conditions (e.g., oxygen level, pH variations, nutrient limitations, high osmolarity, oxidation, peristalsis) prevailing in the different sections of the GIT, which in turn can affect the growth, viability, physiological status, and functionality of microbial cells. Consequently, probiotics have developed a series of strategies, called "mechanisms of stress response," to protect themselves from these adverse conditions. Such mechanisms may include but are not limited to the induction of new metabolic pathways, formation/production of particular metabolites, and changes of transcription rates. It should be highlighted that some of such mechanisms can be conserved across several different strains or can be unique for specific genera. Hence, this review attempts to review the state-of-the-art knowledge of mechanisms of stress response displayed by potential probiotic strains during their transit through the GIT. In addition, evidence whether stress responses can compromise the biosafety of such strains is also discussed.

Case report: First case of early adenoid cystic carcinoma and squamous cell carcinoma collision cancer treated by endoscopic submucosal dissection

Background

Collision cancer, a rare tumor, rarely occurs in the esophagus. Most reported cases of esophageal collision cancers are advanced cancers that can only be treated with surgery or palliative chemoradiotherapy. Here, we report a rare case of collisional squamous cell carcinoma (SqCC) and adenoid cystic carcinoma (AdCC) that was detected in the early stages by endoscopy.

Case summary

A 66-year-old man presented with retrosternal pain after swallowing and underwent endoscopy. Pathological biopsy showed high-grade squamous intraepithelial neoplasia. The lesion was removed by endoscopic submucosal dissection (ESD) after magnification and endoscopic ultrasonography. Postoperative pathology proved that the lesion was collision cancer comprising SqCC and AdCC. After six months of postoperative follow-up, there was no recurrence of esophageal cancer.

Conclusions

We provided a case report related to the diagnosis and treatment of esophageal collision cancer, especially early collision cancer. More research is needed to provide insights into the management of collision cancers.