A quick diagnosis?
This was found in the mid-oesophagus of a 55 year old woman complaining of dyspepsia.
HOW WOULD YOU CONFIRM THE DIAGNOSIS?
■ Take a biopsy
Absolutely, but throw it away afterwards!
■ Organise an EUS
■ Request a CT
Often a sensible answer but in this case it's stupid!
■ Organise an EMR
■ Organise an ESD
If you give this a poke, you will find that it's soft and therefore unlikely to be a leiomyoma. The other pale, submucosal lesion which you often see in the oesophagus are 'granular cell tumours'. Although they can turn large, I've never seen one any larger than a few millimetres in diameter.
How then to prove the diagnosis? Simple, take a biopsy and see the fat flow out of your biopsy site (image below) !!! You can then throw that biopsy sample away (there will only be a normal squamous oesophageal mucosa). Presto - You have just confirmed the diagnosis !!!