Matsumoto Shigeki, Okumura Tomoyuki, Miwa Takeshi, Numata Yoshihisa, Hamashima Takeru, Ito Miki, Nagaoka Yasuhiro, Takeshita Chitaru, Sakai Ayano, Kimura Nana, Fukasawa Mina, Mori Kosuke, Takeda Naoya, Yagi Kenta, Muranushi Ryo, Manabe Takahiro, Shirai Yoshihiro, Watanabe Toru, Hirano Katsuhisa, Hashimoto Isaya, Shibuya Kazuto, Yoshioka Isaku, Fujii Tsutomu
Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Office of Human Research Ethics, Faculty of Education and Research Promotion, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Surg Case Rep. 2024 May 28;10(1):131. doi: 10.1186/s40792-024-01934-6.
Glomus tumors (GT) generally occur in the skin. However, esophageal GT, an extremely rare condition, has no established standardized treatment guidelines. Herein, we report the case of an esophageal GT successfully removed by thoracoscopic enucleation in the prone position using intra-esophageal balloon compression.
A 45-year-old man underwent an annual endoscopic examination and was found to have a submucosal tumor in the lower esophagus. Endoscopic ultrasound (EUS) revealed a hyperechoic mass originating from the muscular layer. Contrast-enhanced computed tomography identified a 2 cm mass lesion with high contrast enhancement in the right side of the lower esophagus. Pathologic findings of EUS-guided fine needle aspiration biopsy (EUS-FNA) revealed round to spindle shaped atypical cells without mitotic activity. Immunohistochemically, the tumor was positive for alpha-smooth muscle actin, but negative for CD34, desmin, keratin 18, S-100 protein, melan A, c-kit, and STAT6. He was diagnosed with an esophageal GT and a thoracoscopic approach to tumor resection was planned. Under general anesthesia, a Sengstaken-Blakemore (SB) tube was inserted into the esophagus. The patient was placed in the prone position and a right thoracoscopic approach was achieved. The esophagus around the tumor was mobilized and the SB tube balloon inflated to compress the tumor toward the thoracic cavity. The muscle layer was divided and the tumor was successfully enucleated without mucosal penetration. Oral intake was initiated on postoperative day (POD) 3 and the patient discharged on POD 9. No surgical complications or tumor metastasis were observed during the 1-year postoperative follow-up.
As malignancy criteria for esophageal GT are not yet established, the least invasive procedure for complete resection should be selected on a case-by-case basis. Thoracoscopic enucleation in the prone position using intra-esophageal balloon compression is useful to treat esophageal GT on the right side of the esophagus.
血管球瘤（GT）通常发生于皮肤。然而，食管GT极为罕见，尚无既定的标准化治疗指南。在此，我们报告一例通过胸腔镜在俯卧位使用食管内球囊压迫成功摘除的食管GT病例。
一名45岁男性接受年度内镜检查时，发现食管下段有一黏膜下肿瘤。内镜超声（EUS）显示一个起源于肌层的高回声肿块。增强计算机断层扫描显示食管下段右侧有一个2厘米的肿块病变，具有高对比度增强。EUS引导下细针穿刺活检（EUS-FNA）的病理结果显示为圆形至梭形的非典型细胞，无有丝分裂活性。免疫组织化学检查显示，肿瘤α-平滑肌肌动蛋白呈阳性，但CD34、结蛋白、细胞角蛋白18、S-100蛋白、黑素A、c-kit和信号转导和转录激活因子6呈阴性。他被诊断为食管GT，并计划采用胸腔镜方法进行肿瘤切除。在全身麻醉下，将一根森斯塔肯-布莱克莫尔（SB）管插入食管。患者置于俯卧位，采用右侧胸腔镜入路。游离肿瘤周围的食管，充盈SB管球囊以将肿瘤压向胸腔。切开肌层，成功摘除肿瘤，未穿透黏膜。术后第3天开始经口进食，患者于术后第9天出院。术后1年随访期间未观察到手术并发症或肿瘤转移。
由于食管GT的恶性标准尚未确立，应根据具体情况选择创伤最小的完整切除手术。胸腔镜在俯卧位使用食管内球囊压迫对治疗食管右侧的GT是有用的。
