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Benign tumors of the esophagus are rare cases encountered by a variety of specialists including gastroenterologists, general surgeons, and thoracic surgeons. The clinical presentation of these lesions may vary from asymptomatic, incidentally discovered tumors (most common) to large lesions resulting in important dysphagia or airway compromise. The development of minimally invasive approaches to esophageal pathology over the last decade has expanded the diagnostic and treatment options for these lesions.
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Benign tumors represent less than 1% of all esophageal tumors, and less than 10% of all surgically resected esophageal lesions.1,2 They may be classified based on either histology or location within the esophageal wall (mucosal, submucosal, or extraluminal) (Tables 29-1 and 29-2). The most common lesions include leiomyomas, esophageal cysts, fibrovascular polyps, and granular cell tumors. Technique for resection is determined based on esophageal layer of origin. The development of endoscopic ultrasound (EUS) has improved the preoperative diagnosis of these lesions and is a helpful adjunct for clinical decision making.
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As with most masses found throughout the human body, benign esophageal tumors were first described on autopsy, long before they could be resected successfully.3 Sussius described what is thought to be the first leiomyoma in 1559. The first “resection” occurred in 1763, when Dallas-Monro used a snare to remove a pedunculated esophageal mass. Ferdinand Sauerbruch, an apprentice of Johann von Mikulicz, is noted to have performed the first partial esophagectomy for a “fibromyoma” in 1932 (Fig. 29-1).4,5 With the advent of positive pressure ventilation and adequate anesthesia, the 1930s and ’40s ushered in an age of rapid advancement in mediastinal surgery, and the literature increased from just a handful of case reports to experiences numbering in the hundreds.
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