A case of esophageal adenocarcinoma presenting as a submucosal tumor

Esophageal submucosal tumors are generally considered benign, and it remains challenging to make a definitive diagnosis for malignant lesions masquerading as submucosal tumors.

A 70 year old male patient underwent gastroscopy, which revealed an irregular submucosal bulge with a smooth surface, measuring approximately 1.5 cm in size and located 30 cm from the incisors. Endoscopic ultrasonography (EUS) demonstrated that the tumor arose from the muscularis mucosae and appeared as a slightly hypoechoic lesion with clear boundaries. Preoperative contrast-enhanced chest computed tomography (CT) detected no abnormal lesions, and an initial diagnosis of esophageal leiomyoma was made. Endoscopic submucosal dissection (ESD) was then performed to resect the lesion. Unexpectedly, postoperative pathological examination confirmed poorly differentiated adenocarcinoma (solid type), with positive vertical resection margin and suspected intraluminal tumor thrombus. The patient was subsequently recommended to receive additional surgical esophagectomy.

Clinicians should keep in mind that esophageal submucosal tumors covered by normal epithelium are not invariably benign. Endoscopic surveillance for such lesions carries potential risks, and adequate communication with patients is therefore mandatory before management.