Abstract
A 69-year-old man with chest pain and fever was found to have a subpedunclated esophageal tumor measuring 15×8 cm located at the lower third of the esophagus, along with incarceration of its distal portion in the stomach. An esophageal gastrointestinal mesenchymal tumor was initially diagnosed based on biopsy results. Furthermore a coexisting primary lung cancer in the the upper part of the right lung was suspected. On admission, the patient developed remittent fever, anemia, and severe malnutrition caused by rapid tumor growth leading to necrosis. It was thought that only extirpation of the entire tumor would allow the patient to recover from his poor general condition associated with his far-advanced tumor stage. Subsequently, definitive surgical treatment (subtotal esophagectomy followed by high-intrathoracic esophagogastrostomy and partial resection of right upper lobe) was planned. Microscopic examination of the surgical specimen revealed a dense proliferation of spindle-shaped tumor cells with an irregular arrangement. On immunostaining, these cells showed a positive response for αSMA, but a negative response for S-100, CD117(c-kit), and CD34. Based on these histopathological findings, a diagnosis of leiomyosarcoma was made. Because the muscularis propria of the esophagus remained intact, the tumor cells might have originated from the muscularis mucosa. The lung tumor was diagnosed as a pulmonary adenocarcinoma. In our paper we report on this very rare case of the giant esophageal leiomyosarcoma arising from the muscularis mucosae with a synchronous primary lung cancer.
