Giant Esophageal Lipoma in an Asymptomatic Patient

Abstract

Purpose: Benign lipomas of the esophagus are extremely rare and account for only 0.4% of the tumors arising from the digestive tract. These tumors arise from the proximal esophagus near the cricopharyngeal muscle. We report a case of an asymptomatic patient with a giant intramural lipoma of the upper thoracic esophagus found incidentally on a CT scan. A 75-year-old asymptomatic white male undergoing a preoperative chest x-ray prior to hand surgery was found to have a mass in the superior mediastinum. Computed tomography (CT) of the chest revealed a polypoid submucosal mass with fat density that arose from the cervical esophagus and extended 12 cm caudally (Fig. 1). Upper gastrointestinal endoscopy showed a submucosal space-occupying mass with normal overlying mucosa. Based upon the above findings, the patient was referred for surgical resection. A vertical esophagotomy was made and the mass was resected along with the pedicle. The pedicle was cauterised. The esophageal incision was then sutured. Pathology of the polyp showed a lipoma comprising of mature adipose tissue collection. The postoperative course was uneventful, and the patient was discharged 3 days after the operation. Giant esophageal lipomas are extremely rare and fewer than 20 surgical cases have been reported in the literature. These are benign slow-growing, pedunculated tumors that usually arise from the upper third of the esophagus. Most cases are asymptomatic and are found incidentally. Symptoms include dysphagia, regurgitation, and epigastric pains. Our case was unique because of the patient was asymptomatic despite the large polyp size. In most cases, the diagnosis is made by endoscopy or barium esophagogram. Diagnosis can also made in a rapid, noninvasive fashion by CT scan which shows low-density tissue absorption related to fatty tissue having (−50 to −150) Hounsfield Units. The size and location often determines the method of resection. Small polyps can safely be removed endoscopically while large masses should be resected surgically because of the risk of bleeding.Figure 1