Gastroenterology clinical image challenge: A 63-year-old healthy woman presented for evaluation of new-onset anemia and weight loss. She denied any gastrointestinal symptoms. Physical examination was unremarkable. An upper endoscopy was performed and showed two subepithelial lesions with normal overlying mucosa in the middle and distal esophagus measuring each around 2 to 3 cm. Endoscopic ultrasound (EUS) examination showed two thin-walled intramural anechoic lesions. The muscularis propria was clearly visualized underneath. The first was located in the middle esophagus and measured 25 × 15 mm. The second was located in the distal esophagus and measured 38 × 18 mm (figure). An EUS-guided fine needle aspirate was performed, and 3 mL of thick mucoid material was aspirated. Cytology showed mature squamous cells.
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