J Gastrointestin Liver Dis, March 2013 Vol. 22 No 1: 8 Download full-text
Giant Esophageal Lipoma Presenting with Gastroesophageal
Suna Yapali1*, Nevin Oruc1, Mustafa Harman2, Ahmet Aydin1
1) Department of Gastroenterology; 2) Department of Radiology, Ege University, School of Medicine, Izmir, Turkey
A 65–year-old lady was admitted with a principal
complaint of heartburn. Upper GI endoscopy revealed an
intraluminal polypoid mass with a stalk occupying ¾ of the
esophageal lumen, originating at 20 cm from the incisors,
with its body extending downward to 30 cm, which measured
about 25 mm in its widest diameter (Fig. 1), associated with
grade B esophagitis . Esophagography showed a flling-
defect with luminal narrowing in the proximal esophagus.
Computed tomography (CT) scans demonstrated a central
fatty mass with a lower density tissue absorption surrounded
by a single ring of normal esophagus (Fig. 2). Endoscopic
ultrasonograpy (EUS) confrmed the submucosal origin of
the mass on the right proximal wall of the esophagus which
was homogeneously hyperechoic with regular margins, image
consistent with lipoma (Fig. 3).
Since she was reluctant to undergo any surgical or
endoscopic excision of the mass during the 3 year follow-
up period, dimensions of the mass lesion were stable and
symptoms of GERD were controlled on esomeprazole therapy.
As the pathophysiological relevance of esophageal lipoma and
GERD was not reported, this case may be assumed to be an
incidental giant esophageal lipoma with rare symptoms of
dysphagia. Although most of the reported cases are treated with
endoscopic and surgical approaches [2-6], the unique feature of
this case is an incidental giant esophageal lipoma presenting
with refux symptoms which remained asymptomatic during
follow-up. Long term follow-up is very important because of
the possibility of metachronous lesions or misdiagnosis of a
well diferentiated liposarcoma. It has been reported that the
tumor may grow 2.5 times over 3.75 years , though it is not
known exactly how long it takes for a lipoma to grow.
IMAGE OF THE ISSUE
Despite the fact that management depends on tumor size,
origin and presence of symptoms, larger tumors may also be
followed endoscopically and endosonograpically in the absence
of life-threatening symptoms.
*Corresponding author: firstname.lastname@example.org
Conficts of interest: None to declare.
1. Armstrong D, Bennett JR, Blum AL, et al. Te endoscopic assesment of
oesophagits: a progress report on observer agreement. Gastroenterology
2. Nagashima M, Ohki I, Nagasato Y, et al. Endoscopically resected lipoma
of the esophagus: report of a case. Digestive Endoscopy 2001;13: 41-
3. Janarthanan K, Shetty S, Mohanakrishnan A, Leelakrishnan. Esophageal
lipoma presenting as along tongue!! Indian J Gastroenterol 2011;30:
4. Murray MA, Kwan V, Williams SJ, Bourke MJ. Detachable nylon
loop assisted removal of large clinically signifcant colonic lipomas.
Gastrointest Endosc 2005;61: 756-759.
5. Lee SH, Park JH, Park do H, et al. Endoloop ligation of large
pedunculated submucosal tumors. Gastrointest Endosc 2008;67: 556-
6. Algin C, Hacioglu A, Aydin T, Ihtiyar E. Esophagectomy in esophageal
lipoma: report of a case. Turk J Gastroenterol 2006;17: 110-112.
7. Hosokawa O, Shirasaki I, Sandou N. Endoscopic removal of esophageal
lipoma. Gastroenterol Endosc 1985;27: 738-743.