Snare traction-assisted endoscopic submucosal dissection for removal of rare giant laryngeal liposarcoma

Abstract

Figures

Endoscopic findings. a Tumor in the larynx. b Esophageal entrance. c Mid-esophagus. d Snare traction.

Computed tomography showing column-like region with a fat-like density in the larynx, without significant contrast enhancement.

The specimen measured 16.5 cm in length and 2.7 cm in width at its widest point.

Histological analysis revealed a well-differentiated liposarcoma. a Hematoxylin and eosin-stained images (× 40). b–e The tumor cells were S100(+) ( b ), CDK4(+) ( c ), P16(+) ( d ), and MDM2(+) ( e ). f Fluorescence in situ hybridization showed that 67% of cells had an amplification of MDM2 copy numbers.

Full text

A 78-year-old man presented with a foreign body sensation in the throat for 1 year. Endoscopy revealed a large pedunculated tumor in the throat, extending deep into the mid-thoracic esophagus ( Fig. 1 ). Computed tomography (CT) of the throat showed a column-like region with a density similar to fat located within the larynx and esophageal entrance to the mid-thoracic lumen, without significant contrast enhancement ( Fig. 2 ).

Endoscopic findings. a Tumor in the larynx. b Esophageal entrance. c Mid-esophagus. d Snare traction.

Computed tomography showing column-like region with a fat-like density in the larynx, without significant contrast enhancement.

We performed endoscopic submucosal dissection (ESD) using a snare to expose and retract the base of the lesion ( Video 1 ). The entire operation lasted 53 min. The tumor was removed through the mouth using the snare ( Fig. 3 ). No adverse events or complications were observed.

Endoscopic submucosal dissection (ESD) was performed to remove a giant laryngeal liposarcoma.Video 1

The specimen measured 16.5 cm in length and 2.7 cm in width at its widest point.

Histological analysis revealed a well-differentiated liposarcoma. Furthermore, fluorescence in situ hybridization demonstrated significant MDM2 gene amplification ( Fig. 4 ).

Histological analysis revealed a well-differentiated liposarcoma. a Hematoxylin and eosin-stained images (× 40). b–e The tumor cells were S100(+) ( b ), CDK4(+) ( c ), P16(+) ( d ), and MDM2(+) ( e ). f Fluorescence in situ hybridization showed that 67% of cells had an amplification of MDM2 copy numbers.

Well-differentiated liposarcomas are frequently encountered in the esophagus and hypopharynx 1 , with rare occurrences in the larynx. While previous reports have described the removal of liposarcomas from the hypopharynx using ESD or surgical resection 2 3 , the excision of laryngeal liposarcomas using ESD has not been reported. Here we present the first reported case of complete excision of a laryngeal liposarcoma using ESD.

The management of large neoplasms can be improved with the use of a snare for applying effective traction. However, its application for the treatment of giant tumors in the larynx has not been documented. In the confined pharyngeal and laryngeal spaces, intraoperative snare-assisted traction of the lesion aids in generating adequate space and offering a clear view, thus enabling complete tumor excision at the basal cut margin. This case demonstrates the efficacy of snare traction-assisted ESD as a minimally invasive, safe, and feasible treatment method for large pedunculated laryngeal tumors. Regular postoperative follow-up is necessary to monitor for local recurrence.

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