Adenoid cystic carcinoma of the gastroesophageal junction- A
Adenoid cystic carcinoma (ACC) is a rare tumor that most commonly develops in the major salivary glands of the head and neck. A few digestive ACC have been reported to date and most of which were esophageal adenoid cystic carcinoma (EACC). Only 1 case of cardial ACC has been reported.

A 44-year-old male was admitted to the hospital in September 2015 with the chief complaint of vomiting blood. His medical history included long-term use of medications (diazepam and sodium valproate tablets) for epilepsy. Laboratory testing revealed mild anemia (hemoglobin level 103 g/L). The serum levels of carcinoembryonic antigen, carbohydrate antigen 199, carbohydrate antigen 125, and alpha-fetoprotein were in the normal ranges. A gastroduodenoscopy identified a protruding lesion with an ulcerated surface in the cardia. A biopsy specimen suggested chronic superficial gastritis. Endoscopic ultrasound (EUS) revealed a solid submucosal mass 2.2 × 3.0 cm in size located 40 cm from the incisors. The mass had a mixed echo pattern with an intact muscularis layer.

Based on the above findings, ESD was performed. First, the lesion area was marked, and the submucosal layer of the lesion was injected with a mixture of glycerin fructose, epinephrine, and indigo carmine. Next, en bloc resection was performed using a hook knife (KD-620LR). During the procedure, cauterization for bleeding on the resected surface was accomplished by argon plasma coagulation.

Source: Medicine: August 2019

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