26285706 Visualization

A 65 Age - year Age old Age female Sex was admitted Clinical_event with progressive Detailed_description dysphagia Sign_symptom for 2 Duration months Duration and 5 Mass kg Mass weight Sign_symptom loss Sign_symptom .
Her past medical history was significant for osteoporosis Disease_disorder treated with calcium Medication lactate Medication tablets Administration , daily Dosage , for 5 Duration years Duration .
Upper Biological_structure gastrointestinal Biological_structure endoscopy Diagnostic_procedure described a 4 Distance cm Distance whitish Color firm Texture mass Sign_symptom in the middle Biological_structure esophagus Biological_structure (Fig.1) and a semi Detailed_description - circumferential Detailed_description deep Severity ulcer Sign_symptom with irregular Shape borders Shape on the opposite Biological_structure mucosa Biological_structure (Fig.2).
During endoscopy Diagnostic_procedure a pedicle Sign_symptom was not identify by handling a polipectomy Diagnostic_procedure snare Diagnostic_procedure around the esophageal Biological_structure mass Sign_symptom .
Upper Biological_structure gastrointestinal Biological_structure series with gastrografin Diagnostic_procedure (Fig.3) revealed an ovoid Shape lacunar Detailed_description image Sign_symptom at the distal Biological_structure part Biological_structure of Biological_structure the Biological_structure esophagus Biological_structure esophageal Biological_structure , inhomogeneous Detailed_description , with calcifications Sign_symptom and smooth Texture contours.
During peristalsis Activity the image Sign_symptom was mobile Detailed_description and no pedicle Sign_symptom was identified.
The esophageal Biological_structure lumen Biological_structure was enlarged Sign_symptom with a diverticula Sign_symptom development at the posterior Biological_structure wall Biological_structure .
Also computer Diagnostic_procedure tomography Diagnostic_procedure of the thorax Biological_structure excluded a pedunculated Detailed_description tumor Sign_symptom , describing an intra Detailed_description - luminal Detailed_description calcified Detailed_description esophageal Biological_structure mass Sign_symptom (Fig.4).
The biopsies Diagnostic_procedure obtained from the esophageal Biological_structure ulcerated Sign_symptom mucosa Biological_structure revealed inflammatory Sign_symptom cells Sign_symptom , without malignancy Sign_symptom .
Based on these endoscopic Diagnostic_procedure and imagistic Diagnostic_procedure results a bezoar Sign_symptom was supposed to have been developed in an esophageal Biological_structure diverticula Sign_symptom , subsequently with ulcerated Sign_symptom mucosa Biological_structure .
The esophageal Biological_structure mass Sign_symptom was removed Therapeutic_procedure with an endoscopic Diagnostic_procedure snare Diagnostic_procedure in one piece, as the fragmentation Therapeutic_procedure was not physically possible.
The macroscopic Diagnostic_procedure appearance Diagnostic_procedure revealed a 4 Distance cm Distance , globular Shape mass Sign_symptom , heterogeneous Detailed_description , dense Detailed_description , whitish Color , in places with harsh Color yellow Color foci Detailed_description , most likely dystrophic Detailed_description calcification Sign_symptom .
The macroscopic Diagnostic_procedure examination Diagnostic_procedure on cross section revealed a light Color gray Color aspect Sign_symptom ( fibrous Texture appearance Texture ) that includes multiple Detailed_description harsh Color yellow Color - orange Color structures Detailed_description , difficult to section (Fig.5).
This mass Sign_symptom was immersed into trichloracetic Diagnostic_procedure acid Diagnostic_procedure for decalcification Diagnostic_procedure .
Microscopic Diagnostic_procedure examination Diagnostic_procedure revealed hyaline Sign_symptom fibrous Sign_symptom tissue Sign_symptom (Fig.6a), stained Lab_value in Lab_value green Lab_value in Tricrom Diagnostic_procedure Mason Diagnostic_procedure (Fig.6b), with numerous crystalline Shape basophils Sign_symptom deposits Sign_symptom of Sign_symptom minerals Sign_symptom , rare Lab_value fibrocytes Diagnostic_procedure and very Lab_value few Lab_value vessels Diagnostic_procedure .
The presence of capillary Sign_symptom structures Sign_symptom , rare Lab_value fibroblasts Diagnostic_procedure and collagen Sign_symptom fibers Sign_symptom brought in discussion a mesenchymal Biological_structure originating Biological_structure mass Sign_symptom , most likely a fibrovascular Disease_disorder polyp Disease_disorder .
A definitive histological diagnosis was not possible, as the pedicle Sign_symptom was not identified, but the presence of the connective tissue suggested the previous presence of a pedicle Sign_symptom into the lesion.
The long term calcium Medication tablets Administration intake might explain the calcification process developed into the vascular-connective tissue, revealed on histology by the numerous crystalline Shape basophils Sign_symptom deposits Sign_symptom of Sign_symptom minerals Sign_symptom .
One Date month Date later Date the patient was asymptomatic Sign_symptom .
The endoscopy Diagnostic_procedure did not revealed an enlarged Sign_symptom esophagus Biological_structure , the appearance Diagnostic_procedure of the esophageal Biological_structure mucosa Biological_structure was normal Lab_value (without ulcerations Sign_symptom ) and no diverticula Sign_symptom was identified.
No motility Sign_symptom disturbances Sign_symptom were found on esophageal Biological_structure manometry Diagnostic_procedure .
Based on the clinical course, the history History of History calcium History lactate History intake History and histological Diagnostic_procedure appearance Diagnostic_procedure a diagnosis of an esophageal Biological_structure benign Severity mesenchymal Biological_structure originating Biological_structure mass Sign_symptom (most probably a fibrovascular Disease_disorder polyp Disease_disorder ) auto Other_event - amputated Other_event and calcified Sign_symptom was formulated.