Alexander M. Carlson, DO, Farhan Azad, DO, Clive J. Miranda, DO, MS, Naren S. Nallapeta, MBBS University at Buffalo, Buffalo, NY
Introduction: Inflammatory fibrous tumor (IFT) is an indolent mesenchymal tumor with a wide variety of nomenclature and definitions. It is typically seen in young male patients and most commonly occurs in the lung. Esophageal IFT is extremely rare and only a few cases have been reported in the literature. We describe an unusual case of this poorly understood esophageal tumor treated effectively by an organ-sparing approach.
Case Description/Methods: A 65-year-old female with a history of gastroesophageal reflux disease presented with complaints of worsening heartburn over the past 4 weeks. Esophagogastroduodenoscopy (EGD) was performed revealing a large, partially-obstructing, mobile, semi-pedunculated, lesion in the distal esophagus (Figure 1, 2). Multiple biopsies at that time were inconclusive. Endoscopic ultrasound (EUS) was not available at that time therefore a computed tomography scan was performed to further characterize the lesion (Figure 3). EUS demonstrated invasion of only the superficial and deep mucosal layers (Figure 4). The lesion appeared to be fluid-filled, but multiple attempts at fine needle aspiration were unsuccessful. Therefore, biopsy was instead performed, demonstrating acute and chronic inflammation, with granulation and fibrous tissue suggestive of an IFT. No evidence of neoplasm was present. On analysis, multiple immunohistochemical markers (DOG1, CD117, S100, desmin, beta catenin, ALK1, SMA) remained negative. The patient was referred to a local cancer institute to undergo a nylon loop ligation device placement for strangulation of the esophageal lesion.
Discussion: Due to the difficulty in establishing the appropriate nomenclature of IFT’s, their incidence and prevalence have been difficult to measure. Furthermore, these languid tumors have a potential for malignant transformation, but it is rare and largely documented in the form of sporadic case reports. Despite the increasing popularity of endoscopic dissection techniques, the mainstay of treatment for IFT’s is confined to radical resections. Here we illustrate the utility of an organ-sparing approach for the treatment of a unique esophageal tumor that is rarely encountered.
Figure: Figure 1: A semi-pedunculated, partially-obstructing, mobile esophageal mass in the distal esophagus Figure 2: A large, mobile esophageal mass dropping into the stomach from the esophagus Figure 3: Soft tissue mass in the distal esophagus with esophageal thickening near the gastroesophageal junction (arrows) Figure 4: EUS demonstrating an intramural, hypoechoic esophageal mass located within layers 1 and 2 of the esophageal wall (arrows)
Alexander Carlson indicated no relevant financial relationships.
Farhan Azad indicated no relevant financial relationships.
Clive Miranda indicated no relevant financial relationships.
Naren Nallapeta indicated no relevant financial relationships.
Alexander M. Carlson, DO, Farhan Azad, DO, Clive J. Miranda, DO, MS, Naren S. Nallapeta, MBBS. P1887 - A Mobile Refluxing Inflammatory Fibrous Tumor of the Esophagus Presenting as Heartburn, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.