Endoscopic Resection of a Giant Esophageal Lipoma Causing Sudden Choking

Dong Ho Jo; Hyung Ku Chon; Sun Ho Woo; Tae Hyeon Kim

doi:10.4166/kjg.2016.68.4.210

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Jo, Chon, Woo, and Kim: Endoscopic Resection of a Giant Esophageal Lipoma Causing Sudden Choking

Case Report

Korean J Gastroenterol 2016;68(4):210-213.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.4.210

Endoscopic Resection of a Giant Esophageal Lipoma Causing Sudden Choking

Dong Ho Jo^*,, Hyung Ku Chon^*,, Sun Ho Woo, Tae Hyeon Kim

Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea

Correspondence to: Tae Hyeon Kim, Department of Internal Medicine, Wonkwang University College of Medicine, 895 Muwang-ro, Iksan 54538, Korea. Tel: +82-63-859-2564, Fax: +82-63-855-2025, E-mail: jipsinsa@naver.com

^* These two authors have equally contributed to this work as co-first authors.

Financial support: This paper was supported by Wonkwang Institute of Clinical Medicine in 2016. Conflict of interest: None.

Received 18 May 2016 Revised 11 August 2016 Accepted 16 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Esophagus, Lipoma, Endoscopy

References

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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.

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).

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.

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).

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