Giant esophageal lipoma presenting with gastroesophageal reflux symptoms.

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 3⁄4 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 [1]. Esophagography showed a llingdefect 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) con rmed 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 followup 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 re ux 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 di erentiated liposarcoma. It has been reported that the tumor may grow 2.5 times over 3.75 years [7], though it is not known exactly how long it takes for a lipoma to grow. IMAGE OF THE ISSUE