Duplicación quística del esófago / Cystic duplication of the esophagus

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical. (Au)

Tumor de céulas granulares del esófago. Estudio morfológico e imunohistoquímico / Granular cell tumor of the esophagus. Morphological and immunohistochemical study

Granular cell tumor or Abrikosoffs tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations. (AU)

Duplicación quística del esófago / Cystic duplication of the esophagus

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.

Tumor de céulas granulares del esófago. Estudio morfológico e imunohistoquímico / Granular cell tumor of the esophagus. Morphological and immunohistochemical study

Granular cell tumor or Abrikosoff's tumor is an infrequent and usually benign neoplasm which is found predominantly in the head and neck region, especially in the tongue. Its esophageal location is unusual, where most of them present as small, well circumscribed lesions which follow a benign course. Because of its low incidence in this site (less than 200 cases having been reported until 1993), we report two cases of esophageal granular cell tumors, both of them in male patients. CASE 1: A 34 year old patient who presented with epigastralgia, heartburn and abdominal distention. He was treated endoscopically because he had a firm new growth in the lower third of the esophagus measuring 1 cm in diameter. CASE 2: A 50 year old patient who presented with digestive tract haemorrhage (hematemesis and melena) 5 cm above the cardias a submucosal polyp was found of 0.8 cm in its largest diameter. MICROSCOPY: Both cases showed a subepithelially located new growth, composed of polygonal cells with eosinophilic granular cytoplasm, small rounded nuclei, and conspicuous intracytoplasmatic positivity for S100 protein. With these elements we reached the diagnosis of granular cell tumor. The bibliography is reviewed and an update is made of its histopathologic characteristics in addition to histogenetic and clinical considerations.