Intra-esophageal whitish mass - a challenging diagnosis.
BACKGROUND
Whitish intraluminal esophageal masses might represent the endoscopic feature of a bezoar or a pedunculated tumor, most likely a fibrovascular polyp, without exclusion of other mesenchymal tumors (leiomyoma, lipoma, gastrointestinal stromal tumor, leiomyosarcoma, granular cell tumor). If a process of dystrophic calcification is also encountered the differential diagnosis can be a challenge even after histological analysis, as it is highlighted by our case.


METHODS
A 65-year-old female whom took lactate calcium tablets for 5 years presented with progressive dysphagia. A whitish esophageal mass with an appearance of a pharmacobezoar was detected at esophagoscopy. A pedunculated tumor was considered in the differential diagnosis, but the imagistic studies ruled out a pedicle. This intraluminal esophageal mass highly suggestive for a pharmacobezoar was endoscopically removed. The challenge of correct diagnosis was raised by histological examination performed after immersion into trichloracetic acid for decalcification. The identification of hyaline fibrous tissue, with numerous crystalline basophils deposits of minerals, rare fibrocytes and very few vessels brought in discussion a mesenchymal originating mass, most likely a fibrovascular polyp, even the pedicle was not detected.


CONCLUSIONS
Based on our challenging and difficult to diagnose case we proposed an uncommon evolution: auto-amputation and calcification of an esophageal mesenchymal originating tumor (most likely a fibrovascular polyp).
Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Croitorilor Street 19-21, Cluj-Napoca, 400162, Romania. ciobanulidia@yahoo.com.
Lidia
L
Ciobanu
Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Croitorilor Street 19-21, Cluj-Napoca, 400162, Romania. opascu@umfcluj.ro.
Oliviu
O
Pascu
Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Croitorilor Street 19-21, Cluj-Napoca, 400162, Romania. matantau@gmail.com.
Marcel
M
Tantau
Emergency Clinic Country Hospital, Cluj-Napoca, 400006, Romania. opinzariu@umfcluj.ro.
Oana
O
Pinzariu
Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, 400162, Romania. bogdanfurnea@yahoo.com.
Bogdan
B
Furnea
Department of Pathology, Emergency Clinic Country Hospital, Cluj-Napoca, 400006, Romania. botanemil@gmail.com.
Emil
E
Botan
Department of Pathology, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, 400372, Romania. taulescumarian@yahoo.com.
Marian
M
Taulescu
D000368:Aged; D001630:Bezoars / Q000139:chemically induced / Q000175:diagnosis*; D017610:Calcium Compounds / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007773:Lactates / Q000009:adverse effects; D011127:Polyps / Q000150:complications / Q000473:pathology*
D017610:Calcium Compounds; D007773:Lactates; C110051:calcium lactate