Estifan Elias, Patel Varun, Grossman Matthew
Department of Internal Medicine, St. Joseph's University Medical Center, New York Medical College, USA.
Division of Gastroenterology, St. Joseph's University Medical Center, New York Medical College, USA.
Case Rep Gastrointest Med. 2019 Sep 29;2019:9869274. doi: 10.1155/2019/9869274. eCollection 2019.
Pyogenic Granuloma (PG), also known as lobular capillary hemangioma, is usually seen as a polypoid red lesion found on the skin or the mucosal surface of the oral cavity. PG of the gastrointestinal tract is rare, in particular involving the esophagus, only 14 cases have been reported in the English literature. We present an 80-year-old male who underwent endoscopy for evaluation of dysphagia and was found to have a single, red, bilobed 10 mm polyp with adherent white exudate approximately 19 cm from the incisors. Endoscopic ultrasound was performed with a 20 mHz miniprobe which showed the lesion contained to the mucosal layer with no muscularis propria invasion. A decision was made to perform endoscopic mucosal resection (EMR). A mixture of saline and methylene blue was injected into the submucosal plane to raise the lesion with subsequent successful mucosal hot snare resection. The resection defect was then approximated and closed with a hemostatic clip to prevent bleeding. Pathology of the specimen revealed small capillary vessels growing in a lobular architecture with an edematous stroma and a florid inflammatory infiltrate representing a pyogenic granuloma. EMR allows for an en bloc resection of mucosal lesions with tumor-free margins, thereby providing both diagnostic and prognostic information. Comparing EMR with the novel technique of endoscopic submucosal dissection (ESD), the incidence of bleeding and perforation is much lower; making EMR the best and safest resection option for this rare hemangioma. In this case, we demonstrate that EMR is a safe technique in removing a pyogenic granuloma in the esophagus.
化脓性肉芽肿（PG），也称为小叶性毛细血管瘤，通常表现为在皮肤或口腔黏膜表面发现的息肉样红色病变。胃肠道的PG较为罕见，尤其是累及食管的情况，英文文献中仅报道过14例。我们报告了一名80岁男性，因吞咽困难接受内镜检查，发现距门齿约19 cm处有一个单一的、红色、分叶状的10 mm息肉，伴有附着的白色渗出物。使用20 mHz微型探头进行内镜超声检查，结果显示病变局限于黏膜层，未侵犯固有肌层。决定进行内镜黏膜切除术（EMR）。将生理盐水和亚甲蓝的混合液注入黏膜下层以抬高病变，随后成功进行黏膜热圈套切除术。然后用止血夹将切除缺损处拉拢并封闭以防止出血。标本病理显示小毛细血管呈小叶状生长，间质水肿，并有大量炎性浸润，符合化脓性肉芽肿表现。EMR能够完整切除黏膜病变并获得无肿瘤边缘，从而提供诊断和预后信息。与新型内镜黏膜下剥离术（ESD）相比，EMR的出血和穿孔发生率要低得多；这使得EMR成为这种罕见血管瘤的最佳且最安全的切除选择。在本病例中，我们证明了EMR是一种安全的技术，可用于切除食管化脓性肉芽肿。
