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  • • Dysphagia often present but frequently mild

    • Sense of pressure in thorax or neck

    • Radiographic demonstration of intraluminal or extraluminal mass, smooth in outline

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Epidemiology

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  • • May arise in any layer

    • -Mucosa

      -Submucosa

      -Muscularis propria

    Mucosa

    • -Squamous papilloma is small, solitary and sessile; usually in distal esophagus; must be differentiated from squamous cell carcinoma by biopsy

      -Fibrovascular polyps are pedunculated; may extend distally to stomach; associated with regurgitation; granular cell tumor is third most common

    Submucosa

    • -Lipoma

      -Fibroma

      -Hemangioma

      -May bleed

    Muscularis propria

    • -Leiomyoma most common

      -Tumor may bleed

      -Biopsy does not penetrate deep enough to sample tumor

      -Rarely malignant

    Cysts

    • -Second most common

      -Most are congenital foregut cysts

      -May cause airway compromise in children

      -Most become symptomatic by adulthood

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Symptoms and Signs

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  • • Often asymptomatic

    • Mild dysphagia

    • Sense of pressure in neck or thorax

    • Gastroesophageal reflux

    • Chest pain

    • Cough

    • Dyspnea

    • Regurgitation

    • Upper GI bleeding

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Imaging Findings

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  • Barium swallow: Reveals a smoothly rounded, often spherical mass that causes extrinsic narrowing of the esophageal lumen

    Esophagoscopy

    • -Intraluminal growths can usually be recognized and a specific tissue diagnosis should always be obtained

      -Because leiomyomas arise from the deeper muscularis propria, endoscopic biopsy will not penetrate deeply enough to reach the tumor

    Endoscopic US: Allows identification of the layer from which the tumor arises and may allow more precise sampling by fine-needle biopsy

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  • • Most benign lesions are asymptomatic, slow growing, have low malignant potential and are discovered incidentally during upper GI contrast radiography or esophagoscopy

    • Leiomyomas and cysts can be distinguished from cancerous growths by their classic radiographic appearance

    • Intraluminal papillomas, granular cell tumors and other benign tumors may be indistinguishable radiographically from early carcinoma, so their exact nature must be confirmed histologically

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Rule Out

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  • • Carcinoma

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  • • Upper GI contrast study

    • Esophagoscopy with biopsy

    • Endoscopic US with fine-needle aspiration (if not performed previously)

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When to Admit

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  • • Severe upper GI bleeding

    • Severe dysphagia prohibiting adequate enteral nutrition

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  • • Most small benign esophageal tumors can be removed endoscopically

    • Larger lesions may require excision or enucleation to confirm diagnosis if symptomatic

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Surgery

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Indications

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  • • Inability to exclude carcinoma

    • All symptomatic lesions

    • All cysts

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Treatment Monitoring

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  • • Interval endoscopy not indicated for excised lesions unless atypical

    • Interval endoscopy indicated for nonexcised, observed lesions

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Complications

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  • • Hemorrhage

    • Obstruction

    • Regurgitation with aspiration

    • Respiratory distress

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Prognosis

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  • • Low rate of recurrence and excellent prognosis after excision of benign esophageal tumors

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References

Yamada H. et al. ...

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