{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:35Z","timestamp":1753891235155,"version":"3.41.2"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Extraskeletal osteosarcoma (ESOS), a malignant soft tissue neoplasm characterized by the presence of osteoid or cartilage matrix, arises without bone involvement. ESOS within the esophagus is particularly rare. This study reported a case of esophageal ESOS with PPM1D-BCAS3 fusion, offering an analysis of its clinicopathological features and a comprehensive literature review aimed at advancing the diagnostic understanding of clinical pathologists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case demonstration<\/jats:title><jats:p>A 76-year-old male presented with a 2-month history of subxiphoid pain and dysphagia. Chest computed tomography CT revealed irregular mid-esophageal wall thickening and luminal stenosis, raising suspicion for mid-esophageal carcinoma. Painless endoscopic ultrasonography detected a hypoechoic intraluminal esophageal mass. Endoscopic submucosal dissection (ESD) and histopathological analysis confirmed primary ESOS of the mid-esophagus. No adjuvant therapy was administered postoperatively. However, the patient experienced a recurrence with multiple metastases 9-months later.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The diagnosis of esophageal ESOS, a condition of exceptional rarity, necessitates an integrative evaluation that encompasses clinical history, imaging modalities, and histopathological analysis, with a critical distinction from metastatic osteosarcoma and carcinosarcoma. This study presented the first case of esophageal ESOS with PPM1D-BCAS3 fusion treated via ESD, providing a significant point of reference for clinicians and pathologists. The management of ESOS demands vigilant monitoring and precise follow-up care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1558831","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T05:25:59Z","timestamp":1750829159000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary extraskeletal osteosarcoma of the esophagus with PPM1D-BCAS3 fusion: a case report and literature 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