Esophageal Pyogenic Granuloma: A Case Report and Review of the Literature

Abstract

Pyogenic granuloma (PG) is a capillary hemangioma mainly found in the skin and oral mucosa, but rarely described in the esophagus. We report the case of a 66-year-old man who consulted for retrosternal pain. Endoscopic studies showed a 28-mm polypoid mass located at the distal esophageal mucosa. The patient underwent endoscopic resection, and the histopathological examination showed a neoplastic proliferation of small blood vessels growing in a lobular architecture, with edematous stroma and prominent inflammatory infiltrate. Special stains for fungus showed pseudohyphae compatible with Candida spp. Findings were consistent with those of an esophageal PG associated with Candida infection. This case is a reminder that PG can be found in the esophagus, can be associated with other entities such as Candida infection, and is one of the differential diagnoses of neoplastic vascular proliferations that may mimic malignancy. In addition, we reviewed previously reported cases of esophageal PG.

Endoscopic Mucosal Resection of a Proximal Esophageal Pyogenic Granuloma

“…The lesion is most commonly found on the skin and the mucosal surface of the oral cavity, nasal cavity , and tongue [6, 7]. Only a few cases have been reported in the gastrointestinal tract including the stomach, duodenum, jejunum, ileum, and colon, with the esophagus being the most common [2]. PG is seen in all parts of the esophagus, with the distal segment (57.1%) being most common, followed by the middle segment (35.7%) [2, 6].…”

“…Only a few cases have been reported in the gastrointestinal tract including the stomach, duodenum, jejunum, ileum, and colon, with the esophagus being the most common [2]. PG is seen in all parts of the esophagus, with the distal segment (57.1%) being most common, followed by the middle segment (35.7%) [2, 6]. On endoscopy, the lesion is usually solitary, appearing in a variety of colors ranging from a bright red/pink to a dark color.…”

“…The size of the lesion can range from several millimeters to a few centimeters. It tends to be friable and hemorrhagic with occasional ulceration and white exudate noted on the surface of the lesion [2, 5, 6, 8, 9].…”

“…Histological characteristics are proliferation and lobular arrangement of multiple capillaries, inflamed, and edematous stroma, and endothelial cell swelling [1, 2]. The etiology has been a matter of debate as discussed in multiple case reports and its theorized that there is an interplay between mechanical irritation, trauma from foreign body, iatrogenic irritation from biopsy, hormonal factors as in pregnancy, and infections from Staphylococci , Helicobacter pylori , Botryomycosis , Campylobacter enteritis , and Candida which may affect the morphology of the lesion [5, 10, 11].…”

“…PG of the gastrointestinal tract is rare, in particular involving the esophagus, only 14 cases have been reported in the English literature. Most PG are managed by snare polypectomy, endoscopic mucosal resection (EMR), laser photocoagulation therapy, endoscopic submucosal dissection (ESD) or regional radiation therapy [2]. In our case, we describe the safety of EMR of a pyogenic granuloma in the esophagus.…”