28353588 Visualization

A 75 Age - year Age - old Age man Sex was referred Clinical_event to our hospital Nonbiological_location for the evaluation of dysphagia Sign_symptom for 9 Duration months Duration .
He had associated symptoms of nausea Sign_symptom and vomiting Sign_symptom but denied hematemesis Sign_symptom , hematochezia Sign_symptom , lethargy Sign_symptom , and dyspnea Sign_symptom .
He was an active History smoker History and consumed History alcohol History for History 30 History years History .
Physical Diagnostic_procedure examination Diagnostic_procedure revealed no peripheral Detailed_description lymphadenopathy Sign_symptom , thyromegaly Sign_symptom , ascites Sign_symptom , or mass Sign_symptom in the abdomen Biological_structure .
Laboratory Diagnostic_procedure data Diagnostic_procedure were normal Lab_value : HBs Diagnostic_procedure - Ag Diagnostic_procedure negative Lab_value , HIV Diagnostic_procedure negative Lab_value , and syphilis Diagnostic_procedure negative Lab_value .
Test for serum Diagnostic_procedure antibody Diagnostic_procedure against Diagnostic_procedure Helicobacter Diagnostic_procedure pylori Diagnostic_procedure was negative Lab_value .
Chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) was notable for a huge Detailed_description well Detailed_description - circumscribed Detailed_description and homogeneous Detailed_description cylindrical Shape mesenchymal Detailed_description neoplasm Sign_symptom measuring 15.5×5.9×4.0 Volume   cm Volume in lower Biological_structure and Biological_structure middle Biological_structure esophagus Biological_structure with mild Detailed_description contrast Detailed_description enhancement Detailed_description (Fig.1A).
CT Diagnostic_procedure revealed no abnormalities Sign_symptom in the lungs Biological_structure , heart Biological_structure , ribs Biological_structure , or mediastinum Biological_structure .
Endoscopic Diagnostic_procedure examination Diagnostic_procedure showed a submucosal Detailed_description lesion Sign_symptom in the esophagus Biological_structure starting at 20 Distance   cm Distance from Distance the Distance incisor Distance teeth Distance extending up Biological_structure to Biological_structure the Biological_structure cardia Biological_structure (Fig.1B).
Endoscopic Diagnostic_procedure ultrasonography Diagnostic_procedure ( EUS Diagnostic_procedure ) revealed hypoechoic Detailed_description lesion Sign_symptom with a clear boundary Detailed_description located in the 4th Detailed_description layer Detailed_description .
The mass Coreference appeared as a benign Sign_symptom tumor Sign_symptom and was preoperatively diagnosed as esophageal Disease_disorder leiomyoma Disease_disorder based on chest CT, endoscopic examination, and EUS findings.
Endoscopic Detailed_description mucosal Detailed_description resection Therapeutic_procedure or endoscopic Detailed_description submucosal Detailed_description resection Therapeutic_procedure was not possible because of large size.
Hence, surgical Detailed_description resection Therapeutic_procedure was planned and informed written consent was taken.
The patient underwent thoracoscopic Detailed_description - assisted Detailed_description resection Therapeutic_procedure of the mass Coreference with gastroesophageal Detailed_description anastomosis Therapeutic_procedure , thoracic Biological_structure duct Biological_structure ligation Therapeutic_procedure , and jejunostomy Therapeutic_procedure .
Postoperative Therapeutic_procedure course Therapeutic_procedure was uneventful Lab_value .
Grossly, a spindle Shape shaped Shape lump Sign_symptom measuring 14 Volume   × Volume   3.5 Volume   × Volume   2.5 Volume   cm Volume , was observed in the resected esophagus Biological_structure , which grew into the esophageal Biological_structure lumen Biological_structure and blocked Sign_symptom most of lumen Biological_structure .
This lump Coreference located in the submucosa Biological_structure was covered Detailed_description with Detailed_description intact Detailed_description mucosa Detailed_description , without erosion Sign_symptom , ulcer Disease_disorder , and hemorrhage Disease_disorder .
Its cut surface was homogenously Color white Color to grayish Color - white Color in color.
Histological Diagnostic_procedure examination Diagnostic_procedure using hematoxylin Diagnostic_procedure and eosin Diagnostic_procedure staining Diagnostic_procedure revealed that tumor Coreference was covered Detailed_description with Detailed_description intact Detailed_description squamous Detailed_description epithelium Detailed_description , arising from Biological_structure the Biological_structure submucosal Biological_structure layer Biological_structure and expanding in to the muscular Biological_structure layer Biological_structure .
The tumor Coreference was composed Detailed_description of Detailed_description many Detailed_description nodules Detailed_description of Detailed_description varying Detailed_description sizes Detailed_description separated Detailed_description by Detailed_description collagen Detailed_description fibers Detailed_description .
Numerous Detailed_description cytoplasm Detailed_description - rich Detailed_description cells Detailed_description were Detailed_description observed Detailed_description in Detailed_description the Detailed_description collagenous Detailed_description septations Detailed_description with Detailed_description invasive Detailed_description growth Detailed_description pattern Detailed_description (Fig.2A–C).
The nodules Detailed_description were Detailed_description mainly Detailed_description composed Detailed_description of Detailed_description small Detailed_description to Detailed_description mid Detailed_description - sized Detailed_description centrocyte Detailed_description - like Detailed_description or Detailed_description monocyte Detailed_description - like Detailed_description cells Detailed_description arranged Detailed_description in Detailed_description diffuse Detailed_description pattern Detailed_description .
These atypical Detailed_description lymphocytes Detailed_description possessed clear Detailed_description boundary Detailed_description , pale Detailed_description cytoplasm Detailed_description , irregular Detailed_description nucleus Detailed_description , and occasional Detailed_description nucleolus Detailed_description (Fig.2D).
Mitosis Diagnostic_procedure was rare Lab_value .
No lymphoepithelial Detailed_description lesion Sign_symptom was recognized in the lesion Coreference .
On immunohistochemical Diagnostic_procedure staining Diagnostic_procedure , epithelium Biological_structure was diffusely Lab_value positive Lab_value for cytokeratin Diagnostic_procedure (Fig.3A), and the tumor Coreference cells Coreference were diffusely Lab_value positive Lab_value for cluster Diagnostic_procedure of Diagnostic_procedure differentiation Diagnostic_procedure (CD)20 Diagnostic_procedure , paired Diagnostic_procedure box Diagnostic_procedure 5 Diagnostic_procedure (Fig.3B), and B Diagnostic_procedure - cell Diagnostic_procedure lymphoma Diagnostic_procedure (Bcl)-2 (Fig.3D).
Small Biological_structure deposits Biological_structure of Biological_structure tumor Biological_structure cells Biological_structure , which were distributed mainly Detailed_description in Detailed_description the Detailed_description collagen Detailed_description fibers Detailed_description , were positive Lab_value for multiple Diagnostic_procedure myeloma Diagnostic_procedure oncogene Diagnostic_procedure 1 Diagnostic_procedure , CD138 Diagnostic_procedure , and CD43 Diagnostic_procedure .
Several Biological_structure tumor Biological_structure cells Biological_structure were also positive Lab_value for CD30 Diagnostic_procedure .
Small Biological_structure lymphocytes Biological_structure were positive Lab_value for CD3 Diagnostic_procedure and CD5 Diagnostic_procedure .
Follicular Biological_structure dendritic Biological_structure cells Biological_structure were positive Lab_value for CD21 Diagnostic_procedure and CD23 Diagnostic_procedure (Fig.3C).
All Biological_structure cells Biological_structure were negative Lab_value for CyclinD1 Diagnostic_procedure , CD10 Diagnostic_procedure , Bcl-6, and B Diagnostic_procedure lymphocyte Diagnostic_procedure specific Diagnostic_procedure activation Diagnostic_procedure of Diagnostic_procedure OCT Diagnostic_procedure binding Diagnostic_procedure protein Diagnostic_procedure 1 Diagnostic_procedure .
These follicular dendritic cells were arranged in nodules in which the tumor cells were relatively evenly distributed.
This pattern was suggestive of follicular colonizations seen in MALT Disease_disorder lymphoma Disease_disorder .
In this case, gene Diagnostic_procedure rearragements Diagnostic_procedure and Diagnostic_procedure clonality Diagnostic_procedure analysis Diagnostic_procedure of immunoglobulin Diagnostic_procedure heavy Diagnostic_procedure chain Diagnostic_procedure gene Diagnostic_procedure , kappa Diagnostic_procedure light Diagnostic_procedure chain Diagnostic_procedure gene Diagnostic_procedure , and lambda Diagnostic_procedure light Diagnostic_procedure chain Diagnostic_procedure gene Diagnostic_procedure was performed using the IdentiCloneTM Detailed_description IGH/IGK/IGL Detailed_description Gene Detailed_description Clonality Detailed_description Assay Detailed_description ( InVivoScribe Detailed_description Technologies, Detailed_description CA Detailed_description ).
On monoclonal gene rearrangement, 1 Lab_value band Lab_value appeared Lab_value within Lab_value 150 Lab_value to Lab_value 175 Lab_value base Lab_value pairs Lab_value (bp) in heavy Coreference chain Coreference gene Coreference , 2 Lab_value discrete Lab_value bands Lab_value within Lab_value 225 Lab_value to Lab_value 250 Lab_value   bp Lab_value in kappa Coreference light Coreference chain Coreference gene Coreference , and 1 Lab_value band Lab_value within Lab_value 125 Lab_value to Lab_value 150 Lab_value   bp Lab_value in lambda Coreference light Coreference chain Coreference gene Coreference (Fig.4).
In addition, no Epstein Disease_disorder – Barr Disease_disorder virus Disease_disorder was observed in this lymphoma on in Diagnostic_procedure situ Diagnostic_procedure hybridization Diagnostic_procedure using the EB Detailed_description virus Detailed_description - encoded Detailed_description small Detailed_description RNA Detailed_description (Fig.3E, F).
Based on the clinical data, pathological, immunohistochemical, and gene rearragements analysis, final diagnosis of primary Detailed_description esophageal Biological_structure MALT Disease_disorder lymphoma Disease_disorder was made.
After the surgical Detailed_description resection Therapeutic_procedure , no additional therapy Therapeutic_procedure in the form of chemotherapy Medication or radiotherapy Therapeutic_procedure was administered.
Over the 8 Duration months Duration of follow Clinical_event - up Clinical_event , no evidence of recurrence Sign_symptom or metastases Sign_symptom was found on CT Diagnostic_procedure and the patient has been asymptomatic Sign_symptom .
Ethical approval for this study was obtained from Medical Ethics Committee of the Third Affiliated Hospital, the Third Military Medical University.
Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.