Synovial sarcoma (SS) in young adult mainly involves periarticular region of the extremities. Synovial sarcomas are exceedingly rare neoplasms of the digestive tract. In this report, we describe a very rare occurrence of primary SS of the esophagus in a 30-year-old female. Patient presented with dysphagia. Endoscopy showed submucosal esophageal polyp. Piecemeal polypectomy was done. Histologically, the tumor demonstrated biphasic morphology with epithelial and mesnchymal component. Tumor cells expressed pancytokeratin, bcl-2 and CD99 antigens. Differential diagnosis of synovial sarcoma and epithelial mesenchymal biphasic tumor was made. Cytogenetics was done to confirm the diagnosis of SS. It showed translocation (x;18). Synovial sarcomas are very rare tumor entities, particularly in the gastrointestinal tract and are likely to be mistaken with other more common tumors such as gastrointestinal stromal tumors.
Heterotopic Gastric Mucosa (HGM) also termed gastric inlet patch or inlet patch, is a rare and benign phenomenon in cervical oesophagus and can be missed during endoscopy. It has an average incidence of 2.5%. Adenocarcinoma arising in the background of gastric heterotopia is very rare and uncommon in the upper oesophagus. A 46-year-old male presented with hoarseness and progressive dysphagia for solids for the past one month. Upper Gastrointestinal Endoscopy (UGIE) revealed a tight stricture at 19-20 cm from the incisors. Initial mucosal biopsies were not conclusive. With high clinical suspicion of malignancy, patient underwent bougie dilation of oesophageal stricture followed by repeat biopsy. Histology revealed an intestinal type of adenocarcinoma, arising in a background of gastric heterotopia of the cervical oesophagus. Alcian Blue/Periodic Acid Schiff (AB/PAS) staining was positive in both the heterotopic glands and in the cancer, indicating the presence of intestinal metaplasia. Tumour cells were immunopositive for cytokeratin-7. A Positron Emission Tomography – Computed Tomography scan revealed a metabolically active lesion located in the upper third of the oesophagus along with uptake in right supraclavicular node. This case report describes a patient with primary intestinal type adenocarcinoma of the cervical oesophagus in the background of HGM not related to Barrett’s oesophagus.
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