Esophageal lipomas (or lipomata) are rare fat-containing esophageal lesions.
They may account for approximately 0.4% of the benign tumors of the alimentary tract 1. There may be greater male predilection. The average age of presentation is around 50 years.
They are usually small, asymptomatic and incidentally detected. When large (>3 cm), patients may present with symptoms such as dysphagia, regurgitation, odynophagia, epigastralgia or hemorrhage.
As with all lipomas, they are composed entirely of mature adipocytes with or without mesenchymal tissue elements. There exists a variety of histological subtypes which include spindle cell lipoma, angiolipoma, myolipoma, fibrolipoma, myxoid lipoma, and the common classic lipoma. Some lesions may be pedunculated.
Fluoroscopy (barium swallow)
They can appear as smooth intraluminal filling defects. Some may be pedunculated.
CT characteristically demonstrates a homogeneous fat attenuation in typical lesions.
Follows fat signal with a high T1 weighted intensity that becomes low intensity on fat-suppressed images.
Possible differential considerations include
- liposarcoma arising from the esophageal region: it can be usually differentiated from liposarcoma which appears as a heterogeneous lesion with internal septations and soft tissue components without fat attenuation.
For atypical lesions consider other esophageal lesions such as
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- 4. Razzak R, Bédard EL, Hunt I, Satkunam N. Spindle cell lipoma of the esophagus. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 35 (3): 542-3. doi:10.1016/j.ejcts.2008.11.016 - Pubmed