Curative endoscopic resection of giant esophageal dedifferentiated liposarcoma: a case report and literature review

Esophageal dedifferentiated liposarcoma (DDLPS) is extremely rare. We report a case of esophageal dedifferentiated liposarcoma (DDLPS) measuring 12.5 × 3.0 × 2.8 cm in a 62-year-old male presenting with a one-year history of progressive dysphagia. Esophagogastroduodenoscopy and computed tomography showed a large pedunculated submucosal tumor arising from the esophageal entrance and extending intraluminally to 35 cm from the incisor teeth, partially obstructing the esophageal lumen. Curative endoscopic resection was successfully achieved using a novel technique employing an externally placed snare and nylon loop outside the endoscope, thereby avoiding traumatic surgical operation. Histopathologic examination showed that the giant tumor was composed of a differentiated lipomatous component adjacent to dedifferentiated spindle cells. Immunohistochemical analysis revealed spindle cells were positive for p16, CDK4, MDM2, CD34, and CD31. The differentiated lipomatous areas were positive for S-100. The definitive pathologic diagnosis confirmed a dedifferentiated liposarcoma, and the margin was negative. This represents the fifth reported case of esophageal DDLPS successfully managed through endoscopic resection. This externally deployed snare and nylon loop technique provides a viable and less invasive alternative for endoscopic resection of large pedunculated esophageal DDLPS. However, long-term follow-up is necessary to evaluate both therapeutic outcomes and prognosis fully.