Endoscopic Resection of Esophageal Lymphangioma Incidentally Discovered

Abstract

A pedunculated lymphangioma of the esophagus was unexpectedly discovered during an endoscopic investigation performed for epigastric pain in a patient affected by diabetic arteriopathy treated with antiplatelet drugs. The patient neither complained of dysphagia nor other symptoms related to the presence of the lymphangioma which therefore can be considered as an endoscopic “incidentaloma”. The lesion was removed endoscopically and a follow up, 6 months later, showed no scar or recurrence. The authors present this case both for the extreme rarity of this lesion and for the evidence of low-medium grade dysplasia in the overlying mucosa, particularly since it is only case ever noted in literature. This aspect suggests that, even if malignant degeneration of these lesions has never been observed, their endoscopic removal is recommended. However, when endoscopic procedures are not feasible, thoracotomic surgical exeresis should be only considered for obstructing and symptomatic lesions; an accurate endoscopic and bioptic follow up can be useful for asymptomatic lesions.

Endoscopic submucosal dissection of esophageal lymphangioma: a case report with a review of the literature

“…Malignant potential has not been reported, except in a case published by Scarpis et al [6] with a focal low-medium grade dysplastic lesion in the mucosa overlying the pedunculated mass. Treatment should be considered when a tumor increases in size or changes in shape in patients without definitive histological diagnosis of lymphangioma, or in patients who have symptoms due to these tumors.…”

“…Lymphangiomas are considered a malformation of lymphatic vessels [5]. Scarpis et al [6] noted that lymphangiomas can be considered hamartomas originating from deep lymphatic structures and that their pathogenesis may be related to cystic dilatation of the enclosed lymphatic tissue. Symptoms depend on the location and the size of the tumors and may be asymptomatic [7] or nonspecific such as epigastric pain, chest pain, dysphagia, and heartburn.…”

“…Esophageal lymphangioma appears as a pale, translucent, and submucosal cystic lesion [6] on endoscopic examination. Analysis of the reports in Japan [5] demonstrated that the tumors are hemispheric or semipedunculated.…”

“…Treatment should be considered when a tumor increases in size or changes in shape in patients without definitive histological diagnosis of lymphangioma, or in patients who have symptoms due to these tumors. There have been eight case reports of endoscopic treatment [snarepolypectomy and endoscopic mucosal resection (EMR)] of these lesions (Table 1) [4,6,8,9,[11][12][13][14][15][16][17][18][19][20][21][22]. If the tumor is small, it can be resected by EMR [8].…”

Lymphangioma of esophagus presenting with dysphagia: A case report

“…Patients may be asymptomatic or may have overt complaints. The most common symptoms are dysphagia, heartburn, postprandial vomiting and epigastric pain, [4,10] although some patients may complain of odynophagia or even midsternal chest pain. Patients with chest pain are especially clinically challenging as a review of the literature shows that many of these patients have esophagitis, hiatal hernia or gastric ulcers, making it difficult to determine the etiology of the complaint.…”