A 56-year-old man was referred to our institution with symptoms of chest discomfort,
which had persisted for a month. The physical examination was unremarkable, and laboratory
data revealed no abnormalities. A barium meal examination showed a round radiolucent
area in the middle third of the esophagus (Figure [1]). Upper endoscopy revealed a sessile, protruding lesion, which was brownish-red
with a white coating on the top (Figure [2]). In view of the patient's symptoms and the risk of bleeding, endoscopic mucosal
resection of the tumor was carried out, without any complications. Histologically,
the tumor was located in the proper mucosal layer, covered by normal squamous epithelium
(Figure [3]). The resected margin was free of tumor cells. High-power magnification showed that
the tumor was composed of various-sized capillaries proliferating in a lobular fashion,
accompanied by an edematous stroma. On the basis of these findings, the tumor was
diagnosed as a pyogenic granuloma. A follow-up endoscopic examination 6 months later
revealed a scarred ulcer, with no evidence of recurrence. In the field of dermatology
and oral surgery, pyogenic granuloma is a common neoplasm, which is considered to
be benign in nature. However, the tumor is known to recur frequently after resection
[1]
[2]. The occurrence of pyogenic granuloma in the gastrointestinal tract is extremely
rare, and only nine such cases have been reported in the literature [3]
[4]
[5]. Pyogenic granulomas of the gastrointestinal tract have been treated using surgical
resection or endoscopic snare polypectomy, due to bleeding or an increase in size.
Recurrences of gastrointestinal pyogenic granuloma have not previously been described
in detail, and the tumor in this case was removed completely using endoscopic mucosal
resection, with no sign of recurrence at 6 months. This procedure may make it possible
to resect pyogenic granuloma completely, as confirmed in this case.
Figure 1 The barium meal examination shows a round radiolucent area, measuring 8 mm in diameter,
in the middle third of the esophagus.
Figure 2 Endoscopy reveals a sessile, protruding lesion. The base is brownish-red and the top
is whitish in color.
Figure 3 A low-powered view shows that the lobulated tumor is located in the proper mucosal
layer (hematoxylin-eosin, original magnification × 4).
