Oesophageal carcinoma mimicking a submucosal lesion: A case report

Oesophageal cancer is the fourth most common cause of cancer-related deaths in India. Esophageal squamous cell carcinomas (ESCCs) arise from the epithelial layer, and commonly present as polypoidal, ulcerative or ulceroproliferative growth in the oesophageal lumen. In contrast, oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme (examples include leiomyoma, fibrovasculoma, lipoma, granular cell tumour or carcinoid), and mostly do not breach the mucosa. Oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme, and mostly do not breach the mucosa. Complete intramural growth of an advanced primary ESCC is an exceedingly rare presentation, with only six cases reported in the literature thus far. We herein report a case of primary ESCC with complete intramural invasion that endoscopically mimics a submucosal lesion.

A 50 year old male presented with a progressive mechanical type of dysphagia for one month. His history was significant, including squamous cell carcinoma of the tongue that was treated with surgery and chemoradiation 1 year prior. Upper gastrointestinal endoscopy revealed a large, hemispherical lesion with normal-appearing overlying mucosa about 4 cm × 5 cm in size extending from 30-34 cm from incisors. The patient underwent endoscopic ultrasound (EUS), and a fine‑needle biopsy was performed, which was suggestive for squamous cell carcinoma. We herein report a case of primary ESCC with complete intramural invasion, endoscopically mimicking a submucosal lesion. The diagnosis could be established only by a EUS-guided biopsy.

This case report highlights that intramural ESCC may look like a submucosal lesion in endoscopy, and EUS biopsy is needed for final diagnosis.