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While generally rare, benign esophageal lesions (e.g., tumors, polyps, or cysts) are of concern because they have the ability to impede the passage of food and, if partially obstructing, can increase the risk of significant aspiration. As a rule, the surgical resection of these lesions is associated with low operative risk and low mortality and is curative in nature. Benign esophageal tumors often are classified in terms of their location (e.g., submucosal, intraluminal, or intramural) and commonly are aligned with specific patterns of presentation that aid diagnosis and, ultimately, management. The most common benign tumor of the esophagus is leiomyoma, which is typically intramural in location. Esophageal cysts are the second most common lesion, comprising approximately 20% of all benign processes. These include congenital and acquired lesions, which are either persistent vacuoles that remain within the esophageal wall during embryologic development or obstructions of the excretion ducts within esophageal glands. The former generally present in the early childhood years, whereas the latter present later in adult life. Intraluminal esophageal polyp is the second most common tumor. Granular cell myoblastoma and hemangioma round out the list of most common benign esophageal tumors, and these usually are classified as submucosal.

The location of the lesion generally is associated with the symptoms. Intraluminal lesions are often associated with dysphagia, vomiting, and poor oral tolerance, as well as cough, substernal distress, and aspiration. Intramural and submucosal lesions are often asymptomatic; however, it is also common to experience dysphagia with submucosal lesions. In general, the standard of care for treatment of benign esophageal tumors or cysts is surgical resection. Frozen biopsy should be performed on all lesions to ensure that the benign preoperative diagnosis is accurate.

In a 30-year review of over 15,000 autopsies, Attah and Hajdu found only 26 cases of benign esophageal tumors, for a prevalence rate of 0.17%, although some have estimated the true incidence to be as high as 0.5% of the general population.1 In the review by Attah and Hajdu, esophageal malignancies were noted to be about five times more common (n = 120). However, while benign tumors and cysts account for fewer than 2% of all esophageal lesions, they reportedly account for up to 10% of all surgically resected esophageal lesions.2 Various classifications have been proposed for benign esophageal tumors. The more commonly used classifications are by histologic cell types or relative location within the esophageal wall (Table 39-1). In general, benign tumors of the esophagus are more common in men than in women and usually become symptomatic after the fourth decade.

Table 39-1. Benign Esophageal Lesions

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