Curative ESD for intraepithelial esophageal carcinoma with leiomyoma mimicking submucosal invasive carcinoma

Figure 1 Esophageal tumor in the middle thoracic esophagus. A: Conventional endoscopy; B: Chromoendoscopy with iodine staining.

Figure 2 Esophageal tumor in the middle thoracic esophagus by magnifying endoscopy with narrow band imaging. A: Dilated and elongated intrapapillary capillary loops on the intraepithelial carcinoma; B: Dilated and elongated intrapapillary capillary loops on the submucosal tumor.

Figure 3 A hypoechoic tumor (4. 2 mm × 2.6 mm) in the muscularis mucosae covered by intraepithelial layer by endoscopic ultrasonography.

Figure 4 Splash-needle.

Figure 5 Esophageal endoscopic submucosal dissection. A: During submucosal dissection. B: Mucosal defect after the procedure.

Figure 6 Resected specimen. A: Macroscopic examination reveals a shallow depression, 34 mm × 26 mm in size in the center of the specimen, with a hard nodule, 5 mm in size, at the proximal edge of the depression; B: Histological examination reveals an intraepithelial esophageal carcinoma overlying a leiomyoma originating from the muscularis mucosae.