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Ng YA, Lee J, Zheng XJ, Nagaputra JC, Tan SH, Wong SA. Giant pedunculated oesophageal liposarcomas: A review of literature and resection techniques. Int J Surg Case Rep 2019; 64:113-119. [PMID: 31630086 PMCID: PMC6806403 DOI: 10.1016/j.ijscr.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022] Open
Abstract
Giant oesophageal liposarcomas, a rare but important cause of oesophageal tumours. A review of the current literature focusing on resection techniques. Shift in the treatment paradigm in recent years to endoscopic resection techniques. Decision on type of resection technique depends on tumour characteristics and location.
Introduction and presentation of case Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of a dedifferentiated oesophageal liposarcoma arising from a giant fibrovascular polyp for which resection was performed via a left cervical oesophagostomy with transgastric retrieval of tumour. We also review the existing literature focusing on discussion of resection techniques. Discussion To date, 62 cases of oesophageal liposarcoma have been reported in the literature. They usually occur in males (74.2%), with a median age of 66 years (range 38–84 years). Such tumours present most commonly with dysphagia (69.4%); usually arise from the cervical oesophagus (79%), and are well-differentiated. Treatment options include surgery and recently, endoscopic resection techniques such as submucosal dissection (ESD). Conclusion Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle. As such, resection techniques have shifted away from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.
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Affiliation(s)
- Y Annalisa Ng
- Department of General Surgery, Changi General Hospital, Singapore.
| | - June Lee
- Department of General Surgery, Changi General Hospital, Singapore
| | - X J Zheng
- Department of General Surgery, Changi General Hospital, Singapore
| | - J C Nagaputra
- Department of Pathology, Changi General Hospital, Singapore
| | - S H Tan
- Department of Pathology, Changi General Hospital, Singapore
| | - S A Wong
- Department of General Surgery, Changi General Hospital, Singapore
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2
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Riva G, Sensini M, Corvino A, Garzaro M, Pecorari G. Liposarcoma of Hypopharynx and Esophagus: a Unique Entity? J Gastrointest Cancer 2017; 47:135-42. [PMID: 26875081 DOI: 10.1007/s12029-016-9808-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Liposarcoma is the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies. It most frequently involves retroperitoneum, trunk, and extremities. Hypopharyngeal and esophageal localization of liposarcoma is extremely rare. METHODS We performed a systematic review of literature and reported 26 and 33 cases of hypopharyngeal and esophageal liposarcoma. We analyzed natural history, imaging features, histology, treatment, and prognosis, with a specific focus to similarities and differences between tumors of hypopharynx and esophagus. RESULTS Hypopharyngeal and esophageal liposarcomas have more similarities than differences. Incidence has a peak at 6th and 7th decades. The diagnostic procedures are barium swallow, endoscopic examination, and CT/MR imaging. Well-differentiated liposarcoma represents the most frequent histological subtype. Surgical excision is the main treatment. Endoscopic resection can be useful for pedunculated tumors of hypopharynx and cervical esophagus. Differences between hypopharyngeal and esophageal liposarcoma are represented by local recurrence rate (greater for hypopharyngeal tumors), number of giant tumors, and time to recurrence (greater for esophageal tumors). Finally, liposarcomas of distal esophagus need more extended approaches. CONCLUSIONS Liposarcomas of hypopharynx and cervical esophagus could be considered a unique pathological entity, with similar features and treatment options. Survival rate is dependent on histological type and location. Local recurrence is common, especially for hypopharyngeal liposarcoma, while the risk of lymph node or distant metastasis is very low. Patients should undergo regular examinations to rule out local recurrence, also for a long time, especially for esophageal tumors.
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Affiliation(s)
- Giuseppe Riva
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Matteo Sensini
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Andrea Corvino
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Massimiliano Garzaro
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giancarlo Pecorari
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
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Dowli A, Mattar A, Mashimo H, Huang Q, Cohen D, Fisichella PM, Lebenthal A. A pedunculated giant esophageal liposarcoma: a case report and literature review. J Gastrointest Surg 2014; 18:2208-13. [PMID: 25190025 DOI: 10.1007/s11605-014-2628-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/04/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The majority of esophageal tumors arise from the mucosal layer; only 5 % are of mesenchymal origins. Of the latter, barely 0.5 % are liposarcomas. We present a case of an esophageal liposarcoma with a review of the literature. CASE REPORT A 64-year-old male was referred with 5 years of progressive dysphagia. Preoperative evaluation initially suggested a leiomyoma. The polypoid lesion was then resected through a cervical esophagotomy, once endoscopic resection proved to be not feasible. The definitive pathologic diagnosis confirmed a well-differentiated liposarcoma. LITERATURE REVIEW Esophageal liposarcomas are very rare and only 40 such cases have been reported in the literature. Most patients were male (80 %), the median age was 62 years (range 38-83 years), and the most common symptom was dysphagia (85 %). Only in two cases was a liposarcoma detected on preoperative biopsy. The most common histological subtype was well-differentiated liposarcoma. Overall, 77.5 % of the patients were successfully treated with surgery, 20 % endoscopically, and 2.5 % were ablated with CO2 laser. CONCLUSION Esophageal liposarcoma is an extremely rare tumor. The majority of patients are males; dysphagia is the most common initial symptom, and preoperative biopsy is unreliable. Because these tumors are pedunculated, well-circumscribed, and well-differentiated, they can be safely resected locally. All patients need long-term follow-up as this disease can recur many decades after treatment.
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Affiliation(s)
- A Dowli
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston VA Health Care System, Harvard Medical School, Boston, MA, USA
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Tirumani H, Rosenthal MH, Tirumani SH, Shinagare AB, Krajewski KM, Ramaiya NH. Imaging of uncommon esophageal malignancies. Dis Esophagus 2014; 28:552-9. [PMID: 24635682 DOI: 10.1111/dote.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malignant esophageal neoplasms other than squamous cell carcinoma and adenocarcinoma are uncommon and include endocrine tumors, lymphoid malignancies, melanoma, malignant stromal tumors, and secondary tumors (metastases). Imaging, though not diagnostic in many cases, helps in selecting the appropriate treatment strategy by determining the anatomic extent of the tumor and locoregional and distant spread. In this article, we provide a comprehensive review of the imaging features of these uncommon esophageal malignancies.
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Affiliation(s)
- H Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - M H Rosenthal
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - S H Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - A B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - N H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Esophageal lipomas are rare tumors, making up 0.4% of all digestive tract benign neoplasms. Most of these lesions are clinically silent as a result of their small size, however, the majority of lesions over 4 cm have been reported to cause dysphagia, regurgitation and/or epigastralgia. We report a case of a 53 year-old African American female who presented with dysphagia. Computed tomography of the chest and esophagram confirmed esophageal lipoma as the cause of the patient's symptoms. Accurately diagnosing an esophageal lipoma is crucial in order to rule out potential malignant lesions, relieve patient symptoms and plan the appropriate treatment.
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Affiliation(s)
- Jeremy Feldman
- Department of Radiology, Hahnemann University Hospital, Philadelphia, PA 19102, USA.
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Rare Cause of Stricture Esophagus-Sarcoma: A Case Report and Review of the literature. Case Rep Gastrointest Med 2011; 2011:192423. [PMID: 22606414 PMCID: PMC3350176 DOI: 10.1155/2011/192423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 07/20/2011] [Indexed: 12/04/2022] Open
Abstract
Adenocarcinoma and squamous cell carcinoma account for the vast majority of oesophageal malignancies. Other malignancies known to occur in the oesophagus include melanoma, sarcoma, and lymphoma. Among the sarcomas, carcinosarcoma is the commonest with both carcinomatous and sarcomatous elements followed by leiomyosarcoma of mesenchymal origin. Other sarcomas reported in the literature are liposarcoma, synovial sarcoma, myxofibrosarcoma, Ewing's sarcoma, granulocytic sarcoma, histiocytic sarcoma, schwannoma rhabdomyosarcoma, and epithelioid sarcoma. We report a case of malignant spindle cell tumour of oesophagus. Sarcomas of esophagus present as a polypoid exophytic soft tissue mass. Our patient presented with a stricture which is a rare presentation. Locally aggressive treatment with surgery is beneficial, and local palliative treatment including radiotherapy is worthwhile.
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7
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Abstract
The so-called "giant fibrovascular polyps" of the esophagus and hypopharynx typically present as sausage-like pedunculated structures that protrude into the lumen and cause obstructive symptoms. Most are cured by local resection but they may recur. Microscopically, they display an admixture of fibrovascular and adipose tissue that is coated by unremarkable squamous mucosa. Here, we report a case that had scattered hyperchromatic cells and lipoblasts within the adipose tissue component. In other anatomic sites similar appearing lesions have been interpreted as pedunculated liposarcomas/atypical lipomatous tumors that are more prone to local recurrences than classic giant fibrovascular polyps. Reports of dedifferentiation and metastases are lacking thus raising the possibility that the cytologic findings in such lesions are degenerative. To confirm our suspicion of liposarcomatous differentiation, we performed immunohistochemistry for MDM2 and p53, 2 markers that are known to be negative in benign lipomatous lesions and positive in well-differentiated liposarcomas/atypical lipomatous tumors. The scattered atypical hyperchromatic cells and the lipoblasts both exhibited strong nuclear staining for both markers and supported the diagnosis of pedunculated giant hypopharyngeal atypical lipomatous tumor.
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8
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Xu S, Xu Z, Hou Y, Tan Y. Primary pedunculated giant esophageal liposarcoma: case report. Dysphagia 2007; 23:327-30. [PMID: 18058173 DOI: 10.1007/s00455-007-9130-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 09/14/2007] [Indexed: 01/01/2023]
Abstract
Liposarcoma is one of the most common soft tissue sarcomas in adults, but the incidence of esophageal liposarcoma is extremely low. To our knowledge there are only 18 cases of esophageal liposarcoma reported in the English-language literature. Here we report a new case of primary esophageal liposarcoma in a 50-year-old male patient who complained of aggravating dysphagia with intermittent vomiting for 6 months. The tumor was located in the upper esophagus. Polypectomy was performed and histologic examination showed a well-differentiated liposarcoma. Diagnostic and therapeutic tools are discussed and the results of a literature review are discussed.
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Affiliation(s)
- Songtao Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Mica L, Gianom D, Bode B, Jaklin P, Hollinger A. Rare cause of dysphagy: giant polypoid esophageal well-differentiated liposarcoma. Case Rep Gastroenterol 2007; 1:7-14. [PMID: 21487465 PMCID: PMC3073781 DOI: 10.1159/000104225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Liposarcoma represents one of the most frequent (10–20%) malignant mesenchymal tumors in the adult, affecting mostly the soft tissue of extremities, the trunk or the retroperitoneum. This tumor type occurs exceptionally rarely in the gastrointestinal tract with only few cases described in the literature. In this case we present a 73-year-old male patient who was admitted due to loss of weight, anorexia and postprandial emesis with dysphagy. Gastrographin esophagography failed to make precise diagnostics. CT scan of the upper gastrointestinal tract revealed a large esophageal tumor filling out the whole length of the esophagus. The tumor was removed by parasternocleidomastoidal approach with a stapler. Histopathological examination revealed a well-differentiated liposarcoma (grade I). Well-differentiated liposarcomas are characterised by amplified material of the 12q13-15 chromosomal region, present in the form of giant or ring chromosomes and leading to the overexpression of MDM2 and CDK4 genes. MDM2 and CDK4 proteins can be detected immunhistochemically, which was the case in the reported tumor. Overexpression of these proteins leads to suppression of tumor suppressor genes, leading to increased cell survival.
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Affiliation(s)
- Ladislav Mica
- Department of Surgery, University Hospital of Zürich, Zürich, Switzerland
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Maruyama K, Motoyama S, Okuyama M, Sasaki K, Sato Y, Hayashi K, Nanjo H, Ogawa JI. Cervical approach for resection of a pedunculated giant atypical lipomatous tumor of the esophagus. Surg Today 2007; 37:173-5. [PMID: 17243042 DOI: 10.1007/s00595-006-3357-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 07/13/2006] [Indexed: 11/26/2022]
Abstract
We describe how we removed a giant pedunculated atypical lipomatous tumor, arising in the cervical to upper thoracic esophagus and occupying a region extending from the cervical to the middle thoracic esophagus, through a cervical esophagotomy without thoracotomy or laparotomy. We suggest that if the base of the tumor is located in the cervical portion of the esophagus, and if the tumor is not aggressive, the cervical approach is best, irrespective of the size of the tumor.
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Affiliation(s)
- Kiyotomi Maruyama
- Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Liakakos TD, Troupis TG, Tzathas C, Spirou K, Nikolaou I, Ladas S, Karatzas GM. Primary liposarcoma of esophagus: A case report. World J Gastroenterol 2006; 12:1149-52. [PMID: 16534863 PMCID: PMC4087914 DOI: 10.3748/wjg.v12.i7.1149] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liposarcoma is the most common soft tissue sarcoma in adult life while esophageal liposarcoma is an extremely rare tumor. In the world literature, only 14 cases of esophageal liposarcomas have been described. We report a 72-year old male patient who was urgently admitted to our hospital for acute epigastric pain with a burning retrosternal sensation, persistent nausea, vomiting and dysphagia. Barium swallow, upper gastrointestinal (GI) endoscopy, esophageal manometry and CT scan, failed to accurately diagnose the lesion. After surgical resection of an esophageal polypoid tumor, the histological examination revealed a well-differentiated grade I liposarcoma. Diagnostic and therapeutic tools were discussed and the results of literature were reviewed.
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Affiliation(s)
- Theodore D Liakakos
- 3rd Department of Surgery, University of Athens, ATTIKON University General Hospital, Haidari, Athens, Greece
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12
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Garcia M, Buitrago E, Bejarano PA, Casillas J. Large esophageal liposarcoma: a case report and review of the literature. Arch Pathol Lab Med 2004; 128:922-5. [PMID: 15270604 DOI: 10.5858/2004-128-922-lelacr] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Liposarcoma is one of the most common neoplasms of adulthood. However, it is exceedingly rare in the gastrointestinal tract. To our knowledge, only 12 cases occurring in the esophagus have been reported in the world literature to date. We report the case of a 42-year-old man with a pleomorphic liposarcoma arising in the esophageal wall. The morphologic, immunophenotypic, and ultrastructural characteristics are presented, as well as the results of literature review.
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Affiliation(s)
- Monica Garcia
- Department of Pathology, University of Miami School of Medicine, Miami, Fla 33136, USA
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13
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Abstract
The peculiar appearance of the proximal esophagus on CT attributed to esophageal lipomatosis is not well recognized. We have recently encountered seven cases from over a period of 2 months and report them to reach a broader audience of radiologists who may be unaware of its existence. Its typical CT features should lead to the correct diagnosis and be differentiated from other fatty lesions known to involve the esophagus, namely, lipoma and liposarcoma.
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Affiliation(s)
- Edith M Marom
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
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