Department of Thoracic Surgery, the Second Hospital of Jilin University, Jilin, China.
Department of Ultrasound Medicine, the Second Hospital of Jilin University, Jilin, China.
Medicine (Baltimore). 2024 Aug 30;103(35):e39507. doi: 10.1097/MD.0000000000039507.
Benign esophageal tumors are uncommon, accounting for approximately 2% of esophageal tumors. Esophageal schwannoma is a much rarer solid tumor with few cases reported in the literature. Open surgery is the surgical approach of choice for the treatment of esophageal tumors. With the advent of thoracoscopy, more and more countries are adopting a thoracoscopic approach to treat esophageal tumors, but there is still no clear surgical standard or modality for the treatment of esophageal tumors.
A 50-year-old woman was admitted to our hospital. Over the past 2 months, her clinical presentation has included progressively worse swallowing disorder and weight loss. Gastroscopy showed an elevated lesion with a smooth surface visible 18 cm out from the incisors. An electron circumferential ultrasound endoscopy showed a hemispherical bulge with a smooth surface 18 to 23 cm from the incisor; the bulge originated from the intrinsic muscular layer and showed a heterogeneous mixed moderate ultrasound with a little blood flow signal and blue-green elastography in 1 of the sections measuring approximately 4 cm × 3 cm. Chest computed tomography (CT) showed a mass-like soft tissue shadow in the upper esophagus measuring approximately 39 mm × 34 mm, with a CT The lumen was compressed and narrowed, and the lumen of the upper part of the lesion was dilated, and the adjacent trachea was compressed and displaced to the right.
After completion of the examination, assisted by artificial pneumothorax and thoracoscopic resection of esophageal masses were performed.
Postoperative pathology report: Mesenchymal-derived tumor (esophagus), combined with immunohistochemical staining results and morphologic features supported schwannoma. The patient's postoperative course was calm. The patient's postoperative dysphagia subsided.
We describe a case of successful treatment of a schwannoma of the upper esophagus using artificial pneumothorax-assisted VATS. The combined use of Sox10 and S100 helps to improve the sensitivity and specificity of schwannoma diagnosis. Damage to the esophageal lining was avoided by mixed thoracoscopic and endoscopic exploration. This approach can also be applied to benign esophageal tumors in the thoracic and subthoracic segments, leading to better minimally invasive results.
良性食管肿瘤并不常见，约占食管肿瘤的 2%。食管神经鞘瘤是一种更为罕见的实体肿瘤，文献报道的病例很少。开放性手术是治疗食管肿瘤的首选方法。随着胸腔镜的出现，越来越多的国家开始采用胸腔镜方法治疗食管肿瘤，但对于食管肿瘤的治疗仍没有明确的手术标准或方式。
一名 50 岁女性因进行性加重的吞咽障碍和体重减轻入住我院。胃镜检查显示门齿 18cm 处可见一隆起性病变，表面光滑。电子环周超声内镜显示门齿 18-23cm 处呈半球形隆起，表面光滑，起源于固有肌层，呈异质性混合中等超声，部分节段血流信号稍多，1 个节段呈蓝绿色弹性成像，大小约 4cm×3cm。胸部 CT 显示食管上段肿块样软组织影，大小约 39mm×34mm，CT 示管腔受压变窄，病变上段管腔扩张，相邻气管受压右移。
完成检查后，在人工气胸的辅助下，行食管肿物胸腔镜切除术。
术后病理报告：间叶源性肿瘤（食管），结合免疫组化染色结果及形态学特征支持神经鞘瘤。患者术后病情平稳，术后吞咽困难症状缓解。
我们描述了一例成功使用人工气胸辅助 VATS 治疗上段食管神经鞘瘤的病例。Sox10 和 S100 的联合应用有助于提高神经鞘瘤诊断的敏感性和特异性。混合胸腔镜和内镜探查避免了食管内膜损伤。这种方法也可以应用于胸段和胸下段的良性食管肿瘤，从而获得更好的微创效果。
