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

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 !!!