Hypopharyngeal dedifferentiated liposarcoma treated by endoscopic submucosal dissection

Published:September 04, 2022DOI:
      A 73-year-old woman visited our institution because of tumor regurgitation. Barium esophagography revealed the long pedunculated lesion in the esophagus (Fig. 1a). Esophagogastroduodenoscopy (EGD) showed the lesion covered with normal mucosa (Fig. 1b). The lesion arose from the hypopharynx, and was completely dissociated from the esophagus. Because she was symptomatic, endoscopic submucosal dissection (ESD) with the use of esophagogastroduodenoscope and the needle- and scissors-type knives was performed under general anesthesia and the insertion of a curved rigid laryngoscope. Macroscopically, the resected mass, measuring 105 × 15 mm in size, consisted of a soft polypoid lesion (Fig. 1c). Microscopically, there were 2 components (Fig. 2a): one area with spindle- to polygonal-shaped tumor cells (Fig. 2b) and the other area with adipocytes and atypical lipoblasts (Fig. 2c). Immunohistochemically, the tumor cells were positive for MDM2, CDK4 and p16. MDM2 gene amplification was detected by fluorescence in situ hybridization (Fig. 2d). The histopathological diagnosis was hypopharyngeal dedifferentiated liposarcoma (DDLS) with well-differentiated liposarcoma component. 18F-fluorodeoxyglucose positron emission tomography and EGD performed six months later showed neither remnant nor metachronous tumor.
      Fig 1
      Fig. 1(a) Barium esophagography reveals the long pedunculated lesion with the smooth surface in the esophagus. (b) Esophagogastroduodenoscopy shows the long pedunculated lesion covered with normal mucosa extending from the hypopharynx to the middle thoracic esophagus. (c) Macroscopically, the mass resected by endoscopic submucosal dissection, measuring 105 × 15 mm in size, consists of a soft polypoid lesion with the smooth surface.
      Fig 2
      Fig. 2(a) Histological examination of the resected specimen. The tumor is comprised of two components. (b) High-power view of the white box in a shows spindle- to polygonal-shaped tumor cells with enlarged, hyperchromatic and irregular-shaped nuclei. (c) High-power view of the black box in a shows various-sized adipocytes and atypical lipoblasts. (d) MDM2 gene amplification is detected by fluorescence in situ hybridization.
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        • Graham R.P.
        • Yasir S.
        • Fritchie K.J.
        • et al.
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