PathWays Case Study: November 21

By April Josselyn • November 21, 2017

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​A 51-year-old man presented with dysphagia and was found to have a 9.0 cm, well-circumscribed submucosal mass in the distal esophagus. Endoscopic ultrasound-guided fine-needle aspiration was performed to evaluate the lesion. A Papanicolaou smear (Figure 1A) revealed the presence of bland-appearing spindle cells. This same spindle cell proliferation was also observed within the cell block material (Figure 1B), and immunohistochemical stains were performed to characterize the lesion, including: KIT (Figure 1C), smooth muscle actin (Figure 1D) and desmin (Figure 1E).

After three months of medical therapy, the esophageal lesion continued to increase in size and the patient had no improvement in his symptoms. The decision was made to proceed to partial esophagogastrectomy. Upon resection, a large submucosal mass was present in the mid-lower esophagus and it showed a tan and glistening cut surface (Figure 2).Microscopically, it displayed spindle cells arranged in fascicles (Figure 3A), and immunohistochemical stains for KIT (Figure 3B), desmin (Figure 3C), and DOG-1 (Figure 3D) are performed.

Heidi Lehrke, D.O.
Fellow, Gastroenterology & Liver Pathology
Mayo Clinic
Follow her on Twitter: @Heidi_Lehrke_DO

Diva Salomao, M.D.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
Follow her on Twitter: @DivaRSalomao

Rondell Graham, M.B.B.S.
Consultant, Division of Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine
Follow him on Twitter: @rondell_graham

April Josselyn

April Josselyn is a Marketing Channel Manager at Mayo Clinic Laboratories. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.