Korean J Gastroenterol.  2016 Oct;68(4):210-213. 10.4166/kjg.2016.68.4.210.

Endoscopic Resection of a Giant Esophageal Lipoma Causing Sudden Choking

• Jo DH
• Chon HK
• Woo SH
• Kim TH

• KMID: 2383517
• DOI: http://doi.org/10.4166/kjg.2016.68.4.210

Abstract

Most esophageal lipomas are discovered incidentally and are small and asymptomatic. However, large (>4 cm) lipomas may cause various symptoms, including dysphagia, regurgitation, or epigastric discomfort. We present a 45-year-old woman with intermittent sudden choking and globus pharyngeus. Upper gastrointestinal endoscopy and endoscopic ultrasound revealed an approximately 10.0×1.5 cm pedunculated subepithelial tumor in the upper esophagus, identified as the cause of her symptoms. A thoracic computed tomography scan revealed a fat attenuated longitudinal mass along the upper esophagus, suggestive of a lipoma. Endoscopic resection of the lesion was performed with a detachable snare to relieve her symptoms, and the pathologic findings were consistent with a lipoma.

Keyword

Esophagus; Lipoma; Endoscopy

MeSH Terms

Airway Obstruction*
Deglutition Disorders
Endoscopy
Endoscopy, Gastrointestinal
Esophagus
Female
Humans
Lipoma*
Middle Aged
SNARE Proteins
Ultrasonography
SNARE Proteins

Figure

• 

  Fig. 1. (A) Endoscopic images showing a pedunculated subepithelial tumor with a large pedicle covered with normal mucosa originating in the cervical esophagus (arrow). (B) Positive “pillow sign” and the yellowish, smooth mucosal surface are visible.

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  Fig. 2. (A) Thoracic computed tomography scan showing a longitudinal mass with fat density (arrow), elongated approximately 8 cm along the upper esophagus. (B) Endoscopic ultrasound showing a hyperechoic lesion with a smooth margin arising from the submucosal layer of the esophagus (arrowheads).

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  Fig. 3. (A) The placement of a detachable snare around the thick stalk of the esophageal subepithelial tumor. (B) Resection defect after removal of the subepithelial tumor using the standard diathermy snare.

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  Fig. 4. (A) Gross finding of the cut surface demonstrating a smooth and yellowish shaped mass, similar to a banana. (B) Histologic examination showing lobules of mature adipocytes, consistent with lipoma (H&E, ×40).

Reference

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