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E-JCRT CORRESPONDENCE
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1031

Large pedunculated lipoma of the esophagus: Report of a case and review of literature


Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhe Jiang University, Hangzhou, People's Republic of China

Date of Web Publication15-Feb-2016

Correspondence Address:
Zhou Shuihong
Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhe Jiang University, Hangzhou 310 003
People's Republic of China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.154089

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 > Abstract 

Large pedunculated esophageal lipoma is uncommon. The presenting symptoms of esophageal lipoma are dysphagia, regurgitated mass, and persistent sensation of a lump in the throat. The most frequent location of the tumor pedicle is the upper esophageal sphincter. Here, we present the case of a 52-year-old man who had the symptoms of pharyngeal unwell and dysphagia. Panendoscopy showed a pedunculated tumor mass within the esophageal lumen with its peduncle arising from the cervical esophagus. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed that he might have anesophageal submucosal or intraluminal and pedunculated tumor mass. The tumor mass measured 25 ΄ 16 ΄ 45 mm in size. Cervical approachvia the right neck was performed for confirmation. After removal of the intraluminal mass, the patient became symptom free. Pathology showed a lipoma arising from the submucosa of the esophagus.

Keywords: Computed tomography, esophagus, lipoma


How to cite this article:
Qinying W, Wei L, Shuihong Z. Large pedunculated lipoma of the esophagus: Report of a case and review of literature. J Can Res Ther 2015;11:1031

How to cite this URL:
Qinying W, Wei L, Shuihong Z. Large pedunculated lipoma of the esophagus: Report of a case and review of literature. J Can Res Ther [serial online] 2015 [cited 2019 Mar 22];11:1031. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1031/154089


 > Introduction Top


Benign tumors of the esophagus are very rare constituting only 0.5-0.8% of all esophageal neoplasms. Approximately, 60% of benign esophageal neoplasms are leiomyomas, 20% are cysts, 5% are polyps, and less than 1% is lipomas. [1] Lipomas have been found in all segments of the alimentary tract. Lesions in the colon occur most frequently, followed in decreased order, by lesions in the small intestine, stomach, and esophagus. [2] Most esophageal lipomas are small, they cause no symptoms and may be found incidentally during imaging studies. [3] Rarely, lipomas become large and cause symptoms such as dysphagia, odynophagia, and surgical excision is required. Herein, we report a case of a 52-year-old man who presented with pharyngeal unwell and dysphagia.


 > Case report Top


A 52-year-old man was admitted to our hospital with pharyngeal unwell since 4months and dysphagia 1 month. The clinical interview disclosed nothing. Physical examination on admission revealed normal findings. Upper gastrointestinal endoscopy revealed a submucosal space-occupying mass with normal mucosa, arising from the posterior wall of the cervical esophagus. Subsequently, the patient had a computed tomography (CT) of the neck and chest. CT study of the neck and chest revealed a low-density tissue absorption submucosal lesion measured 25 × 16 mm and covered by normal mucosa of the cervical esophagus [Figure 1]. Magnetic resonance imaging (MRI) of the neck revealed a hyperintensity tissue absorption submucosal and pedunculated lesion measuring 25 × 16 × 45 mm and covered by normal mucosa of the cervical esophagus [Figure 2]. Thus, a submucosal tumor was identified in this region, and esophageal submucosal lipoma was considered the most likely diagnosis. No lymph node, lung, or liver metastasis was evident. Cervical approachvia the right neck was performed for confirmation. After removal of the intraluminal mass, the patient became symptom free.
Figure 1: CT neck and chest revealed a 25 × 45 mm submucosal lesion of the cervical esophagus. CT = Computed tomography

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Figure 2: MRI illustrates that the submucosal and pedunculated lesion in the cervical esophagus has smooth borders, T1-weighted hyperintensity that becomes hypointense on fat-suppressed images. MRI = Magnetic resonance imaging

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The pathology showed lipoma comprising of a collection of mature adipose tissue [Figure 3]. The postoperative course was uneventful, and the patient was discharged on the 12 th postoperative day after a gastrografin pass to assess the integrity of the esophageal wall [Figure 4].
Figure 3: Photomicrograph showing lobules of mature adipocytes (hematoxylin and eosin (H and E), ×50)

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Figure 4: Postoperative esophageal X-ray using gastrografin swallow

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 > Discussion Top


Benign tumors of the esophagus are very rare. Indeed, tumors including adenoma, fibroma, hemangioma, leiomyoma, rhabdomyoma, lipoma, and lymphangioma, account for less than 1% of all esophageal neoplasms. These masses are usually discovered incidentally, as many of them are small and asymptomatic. [1],[2] More specifically, lipomas of the esophagus are extremely rare, accounting for only 0.4% of all digestive tract benign neoplasms. [3],[4] They generally become symptomatic only when they are large enough to cause dysphagia, at which time they merit surgical excision. [5] Lipomas are found in all areas of the gastrointestinal (GI) tract, most commonly in the colon, followed by the small intestine. Less common locations include the stomach and esophagus. Lipomas throughout the GI tract have an incidence of 1 in 600 necropsies. [4] The likelihood of a lipoma causing symptoms is related to its size. According to Hurwitz et al., no GI tract lipoma under 1 cm caused symptoms, compared with (75%) over 4 cm. [6] Eighty-five percent of lipomas in the esophagus are clinically silent; therefore, the majority of them are found incidentally on radiographic imaging. [7] If symptomatic, patients can experience dysphagia, regurgitation, recurrent melena, and/or epigastralgia. [6],[8] The most frequent complaint is dysphagia. In the report, the case of a 52-year-old man who had the symptoms of pharyngeal unwell and dysphagia.

Most esophageal lipomas are small and occur singly, they do not cause symptoms and do not have to be removed. Generally, lipomas over 2cm in diameter appear capable of producing symptoms. [9] Various management options are available, depending on tumor size and location, and include excision by cervical esophagotomy, minithoracotomy, or endoscopy. Surgical excision (enucleation) is recommended for symptomatic benign tumors and those greater than 5 cm. For our case, the tumor mass measured 25 × 16 × 45 mm in size. Cervical approachvia the right neck was performed to remove the intraluminal mass.

Usually, esophageal lipomas originate in the cervical and upper thoracic esophagus. [5] Establishing a correct diagnosis of an esophageal lipoma demands a careful history, thorough radiographic examination, and/or inspection with upper GI endoscopy. Radiographically, lipomas present as intraluminal filling defects. Useful signs to differentiate lipomas from other benign or malignant lesions include a smooth surface and "squeeze" sign manifested by changes in contour and configuration as a result of peristalsis. [6]

Leiomyomas, the most common benign esophageal tumor, has subtle differences from that of a lipoma. Radiologically, they appear as a well-defined mass with muscle density and occasionally contain nodular calcifications. This translates to a hypoattenuating lesion on CT, a hypoechoic lesion with fine echoes, in the setting of calcifications, on endoscopic ultrasound and a tan mass on upper GI endoscopy. [10],[11] On CT, lipoma presents as a homogenous lesion with fat density. [4],[5] Therefore, a homogenous lesion containing fat density on CT is diagnostic of a lipoma. [4],[12] On MRI, lipomas can be identified by following fat signal as T1-weighted hyperintensity that becomes hypointense on fat-suppressed images. [13] In this report, MRI scan showed nonuniform intensity signals on both T1- and T2-weighted images.

In general, lipomas of the esophagus are rare and are usually discovered incidentally; unless they are large enough to cause symptoms, most commonly dysphagia. CT and MRI are helpful for diagnosis of an esophageal lipoma. Various management options are available, depending on tumor size and location.


 > Acknowledgement Top


The authors express their gratitude to Gui Zhao, MD, at Department of Image Center, The First Affiliated Hospital, College of Medicine, Zhe Jiang University, for his professional critiques and images.

 
 > References Top

1.
Xu GQ, Hu FL, Chen LH, Shan GD, Zhang BL. The value of endoscopic ultrasonography on diagnosis and treatment of esophageal hamartoma. J Zhejiang Univ Sci B 2008;9:662-6.  Back to cited text no. 1
    
2.
Tominaga K, Arakawa T, Ando K, Umeda S, Shiba M, Suzuki N, et al. Oesophageal cavernous haemangioma diagnosed histologically, not by endoscopic procedures. J Gastroenterol Hepatol 2000;15:215-9.  Back to cited text no. 2
    
3.
Mayo CW, Pagtalunan RJ, Brown DJ. Lipoma of the alimentary tract. Surgery 1963;53:598-603.  Back to cited text no. 3
[PUBMED]    
4.
Kang JY, Chan-Wilde C, Wee A, Chew R, Ti TK. Role of computed tomography and endoscopy in the management of alimentary tract lipomas. Gut 1990;31:550-3.  Back to cited text no. 4
    
5.
Wang CY, Hsu HS, Wu YC, Huang MH, Hsu WH. Intramural lipoma of the esophagus. J Chin Med Assoc 2005;68:240-3.  Back to cited text no. 5
    
6.
Hurwitz MM, Redleaf PD, Williams HJ, Edwards JE. Lipomas of the gastrointestinal tract. An analysis of seventy-two tumors. Am J Roentgenol Radium Ther Nucl Med 1967;99:84-9.  Back to cited text no. 6
[PUBMED]    
7.
Taylor AJ, Stewart ET, Dodds WJ. Gastrointestinal lipomas: A radiologic and pathologic review. AJR Am J Roentgenol 1990;155:1205-10.  Back to cited text no. 7
    
8.
Tsalis K, Antoniou N, Kalfadis S, Dimoulas A, Karolidis A, Dagdilelis L, et al. Laparoscopic enucleation of a giant submucosal esophageal lipoma. Case report and literature review. Am J Case Rep 2013;14:179-83.  Back to cited text no. 8
    
9.
Tolis GA, Shields TW. Intramural lipoma of the esophagus. Ann Thorac Surg 1967;3:60-2.  Back to cited text no. 9
[PUBMED]    
10.
Murata Y, Yoshida M, Akimto S, Ide H, Suzuki S, Hanyu F. Evaluation of endoscopic ultrasonography for the diagnosis of submucosal tumors of the esophagus. Surg Endosc 1988;2:51-8.  Back to cited text no. 10
    
11.
Yang PS, Lee KS, Lee SJ, Kim TS, Choo IW, Shim YM, et al. Esophageal leiomyoma: Radiologic findings in 12 patients. Korean J Radiol 2001;2:132-7.  Back to cited text no. 11
    
12.
Thompson WM. Imaging and findings of lipomas of the gastrointestinal tract. AJR Am J Roentgenol 2005;184:1163-71.  Back to cited text no. 12
    
13.
Escobar E, Nguyen BD, Colvin OC. PET/CT and MRI of chondroid lipoma of the deltoid muscle. Clin Nucl Med 2014;39:984-7.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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