Case introduction:
The 53-year-old male patient had a smoking history of 30 years, with an
average of 10 cigarettes per day, and no unsatisfactory clinical
symptoms. Gastroduodenoscopy was performed in Wenzhou Integrated
Traditional Chinese and Western Medicine hospital for routine health
examination, and tumor of the lower esophagus was found. She came to
Wenzhou Integrated Traditional Chinese and Western Medicine hospital for
endoscopic treatment on January 19, 2021. Endoscopic results showed that
a mucosal hump was observed 42cm away from the incisor, with a diameter
of about 1.3*1.2cm, and the mucosa on the surface was smooth (Figure 1).
Endoscopic ultrasonography showed that 42cm from the incisor of the
esophagus, there was a low-echo mass originated from the muscularis
mucosa, with uneven echo and clear boundary. The measured cross-section
was 0.74*0.51mm (Figure 2). The initial diagnosis of it was esophageal
stromal tumor, and the nature of this tumor should await the results of
pathological examination. After admission, relevant preoperative
examinations were completed, and endoscopic resection of lower
esophageal mass was performed on January 20, 2021 after surgical
contraindications were eliminated (Fig 3). Postoperative pathological
findings: one grayish white nodules, diameter 0.8cm, clear boundary, no
capsule, section of grayish white, soft texture. (Fig. 4) The lesion
consists of variously-sized, dilated glandular lumens surrounded by
dense, proliferative lymphoid tissue. The glandular lumen is filled with
abundant clastic red - stained secretions. The inner wall of the
glandular lumen is lined with double-layer epithelial cells, and the
inner epithelial cells are atrophied. The cells are flat, cubic, and a
few are columnar. The epithelial hyperplasia in the focal area folds
into the lumen and shows papillary growth. The basal cells in the outer
layer of the glandular lumen were flat or cubic, with round or flat
nuclei, rare cytoplasm and some transparent cytoplasm. The morphology of
the two layers of cells was mild and no pathological mitosis was
observed. Immunohistochemical staining (Figure 5-6) showed that The
inner epithelial cells of the glandular lumen cytokeratin (Cytokeratin,
CK) positive, CK7 positive, P63 positive cell proportion <
1%, CD20 negative, CD117 negative, thyroid transcription factor-1
(TTF-1) negative, Lymphatic endothelial markers (D2-40) negative, tumor
cell proliferation index in double epithelial cells (Ki-67) negative.