Early adenocarcinoma originating in submucosal gland of thoracic esophagus presenting as submucosal tumor.

of the esophagus is squamous cell carci− noma. The majority of adenocarcinomas of the esophagus originate in the esopha− gogastric junction, Barrett’s esophagus, or ectopic gastric mucosa [1]. Adenocarcino− ma arising in a submucosal gland of the esophagus beneath the squamous epithe− lium is rare [2]. A 43−year−old woman with an esophageal submucosal lesion about 1 cm in size, lo− cated 24 cm from the incisors (l" Fig. 1 a), underwent endoscopic ultrasonography that revealed an isoechoic lesion about 0.5 cm in size over the deep mucosal and submucosal layers of the esophageal wall (l" Fig. 1 b). The patient underwent endoscopic mu− cosal resection using the cap method (EMRC) without complications (l" Fig. 1 c). The resected specimen measured 1 ” 0.5 ” 0.5 cm. Microscopically, a sub− mucosal tumor composed of distorted tubular glands with an infiltration growth pattern was noted. The tumor was confined to the submucosa without involvement of either overlying epithe− lium or muscularis propria. Diagnosis was a tubular adenocarcinoma arising in the submucosal glands (l" Fig. 2). After an explanation of the risks of possi− ble aggressive behavior of adenocarcino− ma of the esophagus, the patient still re− fused surgery or adjuvant radiation ther− apy. To date (18 months of follow−up), there has been no evidence of recurrence or metastasis. There were some concerns: increased depth of tumor invasion increases the risk of lymph node metastases [3], and endoscopic therapy for tumors with sub− mucosal invasion may overlook this risk. Therefore, there are still debates about endoscopic mucosal resection as a treat− ment for early esophageal cancer [4, 5]. In our reported case, the adenocarcinoma arose in the submucosal gland, not in epi− thelium. The definition of this tumor as “early stage” may be somewhat contro− versial. In this case, we considered that local treatment alone was not contraindicated, since both endoscopic image and patho− logical section showed complete resec− tion, and endoscopic ultrasonography and chest CT scan gave no evidence of lymph node metastasis.