A 33-year-old male patient was admitted to the Department of Thoracic Surgery of the Harrison International Peace Hospital (Hengshui, China) in August, 2013, with epigastric pain, difficulty in swallowing and occasional vomiting after eating. The symptoms were aggravated and the patient developed dysphagia, occasionally experiencing acid reflux and heartburn within the last 2 months. Barium swallow examination revealed narrowing of the lumen of the distal esophagus. Upper endoscopy revealed two diverticulum-like lesions, measuring 0.3x0.3x0.3 and 0.3x0.3x0.3 cm, located on the right anterior wall of the esophagus at a distance of ~38 cm from the incisors, and one diverticulum-like lesion measuring 1.0x1.0x0.8 cm, located at 39-40 cm from the incisors. A biopsy from the latter lesion revealed that the tissue was lined by stratified squamous epithelium and the stroma was infiltrated by chronic and acute inflammatory cells.
Intraoperatively, the affected segment of the distal esophagus contained a mass measuring 2.0x2.0x2.0 cm located at 2.0 cm from the cardia. The mass tightly adhered to the esophageal mucosa. On gross examination, the excised esophageal specimen measured 3.5x3.0x1.5 cm and included a mass measuring 2.0x1.5x1.5 cm lying directly underneath the mucosa. On cross-section, the mass was grayish-white and had a hard consistency (Fig. 1).
On microcopic examination, the mass was lined by squamous epithelium and the stroma was mainly composed of chondroid tissue (60%) admixed with adipose tissue (25%) and fibrous connective tissue (15%) (Fig. 2). The final histopathological diagnosis was lower esophageal chondroid hamartoma. There was no recurrence of the tumor during 2 years of postoperative follow-up (last follow-up was in September, 2015).
Informed consent was obtained from the patient regarding the publication of the case details and associated images.