A Case of Esophageal Stricture Due to Metastatic Breast Cancer Diagnosed by Using Endoscopic Ultrasound Guided Fine Needle Biopsy

Metastatic cancer to the esophagus is rare and the breasts are the most common primary tumors that metastasize to the esophagus. Since metastatic breast cancer is located in the submucosal layer, diagnosis by general forceps biopsy is difficult. Hence, various techniques including endoscopic ultrasound guided fine needle aspiration, endoscopic ultrasound guided fine needle biopsy, unroofing technique, and submucosal tunneling method are used for diagnosis. Moreover, the patient's medical history should be inspected carefully and previous histological findings of cancer should also be evaluated. Herein, the authors report a case of metastatic breast cancer along with literature reviews. Endoscopy was performed in patient who had undergone breast cancer surgery 13 years previously. Histological examination from a midesophageal stricture was normal. Endoscopic ultrasound was performed and uneven hypoechoic masses were found in the third layer of the esophageal wall. The esophageal stricture was finally diagnosed as metastatic breast cancer by endoscopic ultrasound-guided fine needle biopsy.

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD. METHODS: In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study. RESULTS: In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%. CONCLUSIONS: We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

A Case of Pneumorrhachis and Pneumoscrotum Following Colon Endoscopic Submucosal Dissection

Endoscopic submucosal dissection has been a useful treatment of selected colorectal neoplasia cases. The incidence of perforation related to colorectal endoscopic submucosal dissection is 5-20%. However, while there have been numerous reports regarding retroperitoneal, mediastinal, pleural and subcutaneous emphysema after therapeutic colonoscopy, pneumoscrotum is a relatively rare manifestation of perforation associated with colorectal endoscopic submucosal dissection. In particular, pneumorrhachis, or air within the spinal cord, following therapeutic colonoscopy, is extremely rare. Herein, we report a conservatively treated perforation case as having pneumorrhachis, penumoscrotum, and pneumoperitoneum after colorectal endoscopic submucosal dissection.

A Case of Gastric Cavernous Hemangioma Diagnosed by Endoscopic Submucosal Dissection

Gastric cavernous hemangioma is a relatively rare benign gastric disease. Gastric hemangiomas are most commonly encountered in adulthood, although they can occur in any age group. While surgical resection is the curative treatment, endoscopic resection can be performed for treatment of selected cases. The patient was a 53-year-old male who was referred for evaluation of incidentally detected gastric subepithelial tumor with dense vascularity and oozing on the apex of the lesion. An EUS revealed a homogenously hypoechoic mass confined to the submucosal layer that showed no continuity with adjacent vessels, and there was no regional lymphadenopathy. Endoscopic submucosal dissection was successfully performed with en bloc resection. The final diagnosis was benign cavernous hemangioma of the stomach.