Zahid Ijaz Tarar, MD, Veysel Tahan, MD, FACG, Ebubekir Daglilar, MD, Omer Basar, MD, Feng Yin, MD; University of Missouri, Columbia, MO
Introduction: Hyperplastic polyps of the esophagus are uncommon.Majority of these lesions are asymptomatic, slow growing,found incidentally and have a low malignant potential. Histologically, these polyps show hyperplastic foveolar and/or squamous epithelium mixed with stroma. Here, we present the second case of esophageal hyperplastic polyp that was grown on a Schatzki’s ring, in the literature.
Methods: A 69-year-old female with a medical history of GERD and scleroderma who was referred by primary care physician for evaluation of worsening solid food dysphagia. She had dysphagia for many years which got worse lately associated with regurgitation of food and atypical chest pain.There was no associated weight loss, nausea, vomiting or diarrhea. Physical examination was notable for diffuse skin tightening consistent with known diagnosis of scleroderma but otherwise unremarkable. An esophagogastroduodenoscopy (EGD) was performed to investigate her symptoms which revealed a 3-cm sliding type hiatal hernia and a Schatzki’s ring. Following careful examination of the distal esophagus and the ring, a subtle nodularity was detected [Fig 1]. The ring was broken with a Savary 48 Fr dilator. Biopsies were obtained from the nodularity separately with biopsy forceps for histopathological examination which showed squamo-columnar mucosa with elongated and irregular hyperplastic foveolar epithelium with cystic dilatations, and acute and chronic inflammatory infiltrates with edematous changes were detected in lamina propria, which were morphologically consistent with esophageal hyperplastic polyp. There was no evidence of intestinal metaplasia or dysplasia [Fig2]. She was started on high dose proton pump inhibitor therapy and follow up EGD was scheduled. Discussion: Although the majority of reported cases are associated with GERD, the pathogenesis of esophageal hyperplastic polyps is not clear. Some studies showed an association between esophageal hyperplastic polyps and Barrett’s esophagus. Abraham et al. presented the first case of esophageal hyperplastic polyp grown on a Schatzki’s ring. To the best of our knowledge, our case is the second case in the literature. Understanding the endoscopic and pathological features of esophageal lesions is essential for their detection, diagnosis, and management. Patients with esophageal hyperplastic polyps need to be observed regularly. It can regress with anti-acid therapy but may need endoscopic mucosal resection if they are causing symptoms when they grow in size.
Hyperplastic Esophageal polyp on a Schatzki's ring.
Histology of Esophageal hyperplastic Polyp.( H&E 40X).
Disclosures: Zahid Ijaz Tarar indicated no relevant financial relationships. Veysel Tahan indicated no relevant financial relationships. Ebubekir Daglilar indicated no relevant financial relationships. Omer Basar indicated no relevant financial relationships. Feng Yin indicated no relevant financial relationships.