Patient with huge upper esophageal hemangioma

Background: Cervical esophageal hemangioma is a rare benign tumor. Symptoms may include hematemesis, dyspnea, cough, dysphagia, and chest pain. Objectives: To describe a case of a large esophageal hemangioma in order to raise awareness of the condition and highlight the use of a cooperative endoscopic treatment approach by a gastroenterologist and otolaryngologist with excellent results. The literature on large esophageal hemangioma is reviewed. Materials and methods: An otherwise healthy male presented with a huge hemangioma of the upper esophagus. Imaging showed the mass hanging on a narrow stalk attached to the posterior wall of the cricopharyngeus muscle, filling the lumen of the cervical and mediastinal esophagus. Resection was accomplished with a combination of flexible gastroscopy and microscope-assisted rigid direct laryngoscopy. Results: Pathologic evaluation showed a polypoid mass covered with squamous epithelium, with multiple engorged blood vessels. Some of the vessels were wide, surrounded by a thin wall, and others were narrow with a thick wall. The histology was compatible with arteriovenous hemangioma. There was no evidence of malignancy. At the 7-month postoperative follow-up, the patient appeared well, with no dyspnea or dysphagia. Our literature search yielded only two published cases of a huge hemangioma of the upper esophagus, which were treated by open resection. Ours is the first report of the use of endoscopic excision. Conclusion: Large esophageal hemangioma should be part of the differential diagnosis of dyspnea, dysphagia, persistent cough, or chest pain. A combined approach by a gastroenterologist and otolaryngologist, working cooperatively, can facilitate the correct diagnosis and provide optimum treatment.