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Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
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A quick diagnosis?

4/2/2021

Comments

 
Picture
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
No need!
■ Request a CT
Often a sensible answer but in this case it's stupid!
■ Organise an EMR
Nope!
■ Organise an ESD
Wrong again!
explanation
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 !!! 
Picture
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