Esophageal Sarcomatoid Carcinoma: A Case Report and Review of Endoscopic Resection: 668

Introduction: Esophageal sarcomatoid carcinoma is a rare cause of esophageal malignancies constituting less than 2% of all cases. Presentation is usually secondary to dysphagia, and diagnosis is made by endoscopy and biopsy showing both carcinomatous and sarcomatous components. Endoscopic resection is thought to be safe and effective management option. Case Presentation: We present a 51-year-old male who was complaining of dysphagia for both solids and liquids for the last for 6 weeks with a 20-pound weight loss. An EGD showed a large pedunculated polyp. Ultrasound was then performed and showed a polyp attached to the esophageal wall without infiltration and no large vessels seen on Doppler, and no enlarged mediastinal or paraesophageal lymph nodes. A repeat procedure for excisional biopsy was attempted under maximum anesthesia care. Cardiothorasic surgery team was consulted and was ready to intervene in case complications to endoscopic resection were faced. Biopsy was taken successfully but mass resection using a snare was unsuccessful given its large size. Pathology results showed sarcomatoid carcinoma after which oncology team was consulted and recommended esophagectomy. A month later the patient underwent a transhiatal esophagectomy with gastroplasty and pull-through without any intraoperative complications, though later the course was complicated by controlled anastomosis leak. Discussion: Previously the endoscopic resection was shown to be a safe procedure for esophageal polypoid lesions after assessing the base with endoscopic ultrasound for vascular structures. In this case, that approach was a challenge due to the large size of the tumor. Treatment for esophageal sarcomatoid carcinoma is achieved by endoscopic resection combined with adjunct radiation and chemotherapy.