Oesophageal lipomas are rare fat containing intrathoracic lesion.
They may account for approximately 0.4% of the benign tumours of the alimentary tract 1. There may be greater male predilection. The average age of presentation at around 50 years.
As with all lipomas, they are composed off 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.
In terms of location, they most commonly occur in the upper one-third of the oesophagus but can potentially occur anywhere from the pharynx to the distal oesophagus.
They are usually small, asymptomatic and incidentally detected. When large (>3 cm), patients may present with symptoms such as dysphagia, regurgitation, epigastralgia or haemorrhage which would warrant surgical excision.
Fluoroscopy (Barium swallow)
They can appear as smooth intraluminal filling defects. Some may be peduculated.
CT characteristically demonstrates a homogeneous fat attenuation in typical lesions.
Follows fat signal with high T1 weighted intensity that becomes low intensity of fat-suppressed images.
Possible differential considerations include
- liposarcoma arising from oesophageal region: iIt 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 oesophageal lesions such as
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