Esophageal spindle cell lipoma

Abstract

Symptomatic ordinary esophageal lipomas are rare tumors. Spindle cell lipomas (SCLs) of this location are even more infrequent. To our knowledge, only a previous esophageal SCL case has been reported. We describe herein the case of a 62-year-old woman with a long history of heartburn and feeling of abdominal distension. Preoperative investigations, including a Barium meal, gastroscopy, and echoendoscopy revealed a lipomatous polypoid mass attached to the middle esophageal segment. The lesion (3.5×2×1 cm) was excised endoscopically under deep sedation. The final histopathology diagnosis was pedunculated SCL. An accurate diagnosis of esophageal SCL is crucial to rule out malignant lesions, relieve symptoms, and undertake suitable treatment. The main differential diagnosis includes well-differentiated sclerosing liposarcoma, atypical spindle cell∕pleomorphic lipomatous tumor, giant fibrovascular polyp, and fat-forming solitary fibrous tumor. Although rare, SCL should be added to the list of lipomatous tumors that can affect the esophagus. Complete excision is the appropriate treatment.

Figure 1

Gastroscopy and esophageal sonography: (A) Gastroscopy shows an intraluminal, yellowish, polypoid mass originating from the esophagus; (B) Sonographically, the lesion is hyperechoic, and homogeneous suggesting an esophageal lipoma

Figure 2

Macroscopic aspect of the intraluminal esophageal polypoid mass. The lesion is covered entirely by mucosa

Figure 3

Panoramic view of the neoplasia: (A) A squamous mucosa covers the well-demarcated lipomatous tumor; (B) In the lamina propria of the mucosa, occasional venous vessels are filled with blood. Hematoxylin–Eosin (HE) staining: (A and B) ×40

Figure 4

Tumor components in varying proportions: (A) The neoplasia contains mature adipose cells and randomly oriented bland spindle cells; collagen bands are seen between the cellular elements; (B) Area showing prominent spindle cell component and abundant rope-like collagen bands. HE staining: (A) ×100; (B) ×200

Figure 5

Spindle cells have ovoid, slender, uniform nuclei with inconspicuous nucleoli and scant cytoplasm; between them, abundant thick, eosinophilic, refringent, ropy collagen bands can be observed. HE staining, ×400

Figure 6

Immunohistochemical study: (A) Intense positivity of the spindle cells for CD34 (×100); (B) Scattered abundant mast cells are revealed by CD117 (×200). CD: Cluster of differentiation