Giant esophageal lymphangioma.

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A 53-year-old man was referred to us with a 3-year history of dysphagia and regurgitation. Transnasal esophagoscopy detected a 24-cm soft-tissue mass that had originated immediately inferior to the cricopharyngeus muscle and extended into the distal esophagus (figure). An endoscopic resection was attempted, but it was unsuccessful because the base of the lesion was very broad (4 cm). A complete removal of the mass was achieved via a transcervical approach with a lateral pharyngotomy. Pathologic analysis identified the mass as a lymphangioma.

Esophageal lymphangioma is a rare clinical entity, as only 14 cases have been reported in the literature. This lesion has the appearance of a fibrovascular esophageal polyp. The most common presenting symptoms are dysphagia, heartburn, postprandial vomiting, and epigastric pain. No case of malignant transformation has been reported. The largest previously reported esophageal lymphangioma measured 5 cm in length. Persistent symptoms and risk of asphyxiation with large tumors are indications for surgical resection.

Melanie W. Seybt, MD; Gregory N. Postma, MD

From the Center for Voice and Swallowing Disorders, Department of Otolaryngology, Medical College of Georgia, Augusta.