case_images: PMC5376932_01
case_images: (a) Endoscopic finding. A large, whitish-yellow, translucent mass with a lustrous surface in the mid and distal esophagus, located 32 to 38 cm from the incisors. (b) Endoscopic ultrasound finding. A honeycomb-like hypoechoic structure measuring 60 x 10 mm located in the submucosa with heterogenous echo pattern; the muscularis propria was intact. (c)-(d) Abdominal CT. Contrast-enhanced CT showed the lesion located in the lower esophagus. (e)-(h) The esophageal mass was resected by endoscopic piecemeal mucosal resection (EPMR). (i) Histology of the resected mass showing cystically dilated lymphatics in the surface squamous epithelium and in the submucosa. (hematoxylin and eosin [H&E], magnification x200).
case_images: CRIM2017-5747560.001.jpg
case_images: PMC5376932_01_CRIM2017-5747560.001.jpg
case_images: fig1
case_images: The endoscopy after admission revealed a large, whitish-yellow, translucent mass with a lustrous surface in the mid and distal esophagus located 32 to 38 cm from the incisors (Figure 1(a)). Endoscopic ultrasonography (EUS) demonstrated that there was a honeycomb-like hypoechoic structure measuring 60 x 10 mm located in the submucosa with a heterogeneous echo pattern and revealed that the muscularis propria was intact (Figure 1(b)). Contrast-enhanced CT of the esophagus showed the lesion located in the lower esophagus (Figures 1(c) and 1(d)). The superficial layers of the esophageal wall were clean and contained no significant bleeding (Figures 1(e)-1(h)). Histology of the resected specimen showed cystically dilated lymphatics in the surface squamous epithelium and the submucosa, focally in the muscularis propria with lymphoid fluid in the lumen, and lymphoid aggregates in the stroma between the vessel walls, consistent with lymphangioma (Figure 1(i)).