Clin Endosc > Volume 56(5); 2023 > Article
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Kim and Ahn: Unusual cause of persistent chest pain

Quiz

A 71-year-old man visited our hospital with one-month long chest pain. He was diagnosed with essential hypertension over the past 20 years. He had never undergone an esophagogastroduodenoscopy (EGD). He had lost 8 kg of body weight in the last 2 months. Initial EGD performed at another institution revealed a large mass in the thoracic esophagus.
Physical examination revealed no remarkable findings. Blood test results were within the normal range, except for a C-reactive protein level of 1.04 mg/dL (normal range: less than 0.6 mg/dL). Reexamination with EGD at our hospital revealed a large ulceroinfiltrative mass occupying two-thirds of the esophageal lumen between the upper incisors at 22 and 34 cm (Fig. 1). Chest and abdominopelvic computed tomography (CT) scans revealed focal esophageal wall thickening in the midesophagus and enlarged lymph nodes in the right upper paratracheal, left gastric, and retroperitoneal regions. F-18 fluorodeoxyglucose positron emission tomography-CT (F-18 FDG PET-CT) revealed hypermetabolism in the affected areas (Fig. 2). Histological findings and immunostaining results for cytokeratin, HMB45, P40, and S100 are shown (Fig. 3). What was the most likely diagnosis?
 

NOTES

Conflicts of Interest
Ji Yong Ahn is currently serving as a KSGE Publication Committee member in Clinical Endoscopy; however, Ji Yong Ahn was not involved in the peer reviewer selection, evaluation, or decision process of this article. Yuri Kim has no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: YK, JYA; Data curation: YK, JYA; Supervision: JYA; Writing–original draft: YK; Writing–review & editing: JYA.

Fig. 1.
Endoscopic image of the esophageal mass. Esophagogastroduodenoscopy reveals a large ulceroinfiltrative mass occupying two-thirds of the esophageal lumen. Black mucosal pigmentation is observed around the mass.
ce-2023-078f1.jpg
Fig. 2.
Coronal view of F-18 fluorodeoxyglucose positron emission tomography-computed tomography. A diffuse hypermetabolic mass is visible in the midthoracic esophagus. Multiple hypermetabolic lymph nodes are visible in the mediastinal, right upper paratracheal, upper paratracheal, and retroperitoneal regions.
ce-2023-078f2.jpg
Fig. 3.
Histopathologic finding of the esophageal mass. (A) Hematoxylin and eosin stain of the esophageal biopsy shows numerous black pigmented cells (×20). (B) Immunohistochemistry staining showing HMB-45 and S-100 positivities. P40 is weakly positive, while cytokeratin (CK) is negative (×10).
ce-2023-078f3.jpg

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