Bizarre Stromal Cells in the Esophagus Mimicking Invasive Malignancy

Ayat Al-Oqaily, Najla AlDauod, Ismail matalka

Abstract


Bizarre stromal cells in the esophagus are an uncommon finding invariably seen in distal esophagus usually in association with inflammatory polyps, chronic ulcers, reflux esophagitis and granulation tissue. We report details of a case of atypical stromal cells mimicking invasive malignancy.
A 55 year old male previously healthy, presented with epigastric abdominal pain. Clinical examination was normal. Upper gastrointestinal endoscopy revealed small hiatal hernia and swelling at the gastroesophageal junction. Microscopic examination showed numerous hyperchromatic large cells of high nucleus to cytoplasm ratio, dispersed chromatin and prominent one to two nucleoli infiltrating multiple esophageal fragments. The cells were positive for Vimentin, focally positive for cyclin-D1 and CD31 immunostains and were negative for cytokeratin, LCA, Melan-A, CD34, Desmin, smooth muscle actin, CMV, CD117 and other immunostains. On follow up biopsies the cells disappeared and the patient is doing well.
Atypical stromal cells are commonly seen in tissues such as vagina and nasal cavity and they are known pitfalls for misdiagnosis of malignancy. Awareness of the presence of atypical stromal cells in the esophagus and gastrointestinal tract is crucial to avoid misinterpretation of invasive malignancy.

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