Shinshu Med J, 64⑵ :75〜78, 2016

A Case of Esophageal Hemangioma Successfully Treated
by Endoscopic Injection Sclerotherapy
Tomoaki SUGA , Takuma OKAMURA , Yugo IWAYA , Tetsuya ITO
Norikazu ARAKURA , Takeji UMEMURA and Eiji TANAKA
1) Department of Medicine, Shinshu University School of Medicine
2) Endoscopic Examination Center, Shinshu University School of Medicine

A 44‑year‑old man was referred to our hospital for therapy for an esophageal hemangioma that had
increased remarkably in size over three years of endoscopic follow‑up.Although the patient had no history ofdysphagia or hematemesis, prophylactic removal of the tumor was planned to prevent hemorrhage. The
hemangioma was treated successfully by two rounds of endoscopic injection sclerotherapy (EIS) using 5 %monoethanolamine oleate. Only mild chest pain was noted during therapy.
Esophageal hemangioma is a rare disease that may cause bleeding or difficulty eating.Surgical resection,
endoscopic mucosal resection, endoscopic submucosal dissection, and laser therapy have all been reported astreatment measures for these lesions.We opted for EIS in the present case because of its low invasiveness andability to treat lesions protruding from the esophageal wall.Blood flow volume and the precise location of thetumor in the esophageal wall should be evaluated by imaging examinations when deciding on the treatment
for esophageal hemangioma. Shinshu Med J 64 : 75 ―78, 2016
(Received for publication November 18, 2015;accepted in revised form December 8, 2015)
Key words:esophagus, hemangioma, therapy, endoscopic injection sclerotherapy

Case reportphy (EUS) examination. The majority of the mass
was located in the submucosal layer,with a part ofA 44‑year‑old man was referred to our hospital

it protruding from the esophageal wall through thedue to the remarkable growth of an esophageal

muscle layer (Fig. 2). Computed tomography (CT)hemangioma over the course of three years of

examination disclosed thin staining of the lesion

endoscopic follow‑up. He had no complaints ofduring late phase contrast enhancement (Fig. 3).

dysphagia or hematemesis. The tumor was detect-

The diagnosis of cavernous hemangioma was madeable as a soft dark‑bluish submucosal lesion in thebased on these ﬁndings.Although the patient experi-thoracic esophagus. It was 40 mm in length, oc-

enced no additional symptoms, prophylactic

cupied approximately one third of the esophageal

removal of the tumor was planned to reduce the risk

circumference, and contained reddish areas in en-of hemorrhage since the lesion had been expanding

doscopic examination (Fig. 1).The lesion appeared

and parts of the mucosal surface were thinning.We

as an isoechoic heterogeneous mass with partiallyselected endoscopic injection sclerotherapy (EIS)hypoechoic structures in endoscopic ultrasonogra-

for the initial treatment primarilybecause of its lowinvasiveness. Endoscopic resection was contrain-

Corresponding author:Takeji Umemura
Department of M edicine, Shinshu University School ofMedicine, 3‑1‑1 Asahi, M atsumoto, Nagano 390‑8621,

dicated due to an elevated risk of massive bleeding
and perforation of the esophagus from the protrud-Japan

ing tumor. EIS of the hemangioma was performed

E‑mail:tumemura＠shinshu‑u.ac.jp

using 5% monoethanolamine oleate(EO)containing

No. 2, 201675

Suga.Okamura.Iwaya et al.

Fig. 1

Endoscopic ﬁndings prior to treatment.
a :The lesion appears as a dark blue swelling in the submucosal layer.
b :A red spotted area can be seen at the top of the lesion (arrows).

Fig.2 Endoscopic ultrasonography(EUS)image
acquired with a 20 M Hz miniature probe showing
an isoechoic mass (arrows)localized mainlyin thesubmucosal layer and partially protruding fromthe esophageal wall through the muscle layer(arrowheads).

Fig. 3 Computed tomography (CT) image
revealing thin staining of the lesion during latephase contrast enhancement (arrows).

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Esophageal hemangioma treated by endoscopic injection sclerotherapy

iopamidol according to our institutional EIS procedures for esophageal varices. After a total of 4 ml
EO was injected into the hemangioma from two
injection points, the multinodular structure that
represented the hemangioma was visualized by X‑
ray ﬂuoroscopy (Fig. 4). The EO remained in thehemangioma for a relatively long time, which indicated slow blood ﬂow in the tumor. No adverse
events were observed apart from mild chest pain.
The hemangioma became markedly reduced in size
but was still present during endoscopic examination
six months later. Thus, a second round of EIS
therapy was carried out using a total volume of 4.5
ml EO into three injection points.The patient complained of mild chest pain similar to that in the ﬁrst

Fig. 4 Endoscopic hemangiogram during injectionsclerotherapy.The cavities and vessel structures ofprocedure. Periodic follow‑up endoscopic examina-

the hemangioma are visible (arrows).

tions have conﬁrmed the disappearance of the lesion
for at least 18 months (Fig. 5).
Discussion
Esophageal hemangioma is a rare disease that
accounts for 2‑4% of benign esophageal tumors .It
is usually detected by endoscopy as a soft dark‑
bluish submucosal tumor which is relatively easy todistinguish from other tumors. Although typicallyharmless when small,advanced cases of esophageal
hemangioma may pose a risk of bleeding and passage obstruction. However, there exists no established treatment approach for such larger lesions.
As venous anomalies, hemangioma lesions often
possess slow blood ﬂow in tumor masses, which isFig. 5 Endoscopic examination 18 months after
treatment shows residual scars only (arrows).

why endoscopic resection and EIS can be applied inmany cases.Tumors can also be removed by endoscopic mucosal resection or endoscopic submucosal
dissection if they are restricted to the mucosal or

5% EO containing iopamidol in the present casesubmucosal layer, but those that protrude from thesince it is most commonly employed for sclerother-esophageal wall,as in this case,should not be resect-apy of esophageal varices at our institution. It

ed endoscopically due to a high risk of hemorrhage

makes the sclerosant visible in the esophageal wall,or perforation .Thus,we opted for the mildly inva-

so that we can inject an adequate quantity to avoid

sive EIS as the ﬁrst treatment for our patient.

hemolysis and perforation as side eﬀects of scleroth-

Absolute ethanol,1% polidocanol,and 5% EO thaterapy.

is typically used for sclerotherapy of esophageal

Surgical resection is generally considered to bevarices has been reported as eﬀective for sclerother-

preferable over endoscopic therapy when blood ﬂow

apy of hemangioma in two case reports .We usedin the tumor is abundant or when the lesion extends

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Suga.Okamura.Iwaya et al.

prominently from the esophageal wall . Hence,tumors or those that cannot be treated by otherlesion blood ﬂow should be assessed using enhanced

measures.

CT examination and/or EUS to rule out the optionof endoscopic treatment.

In conclusion, we encountered a rare case ofesophageal hemangioma that could be resolved

Lastly, potassium titanyl phosphate/yttrium alu-

successfully with EIS following consideration of theminum garnet laser therapy has also been reportedtumor location and blood ﬂow.Further consensus isas eﬀective for esophageal hemangioma .However,needed on the conventions for treatment of thisfrequent doses of radiation are required to eradicate

disorder.

lesions, which may be most suitable for smaller
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（2015.11.18 received ; 2015.12. 8 accepted）

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