Esophageal Tumors, Benign

• • Dysphagia often present but frequently mild

  • Sense of pressure in thorax or neck

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

Epidemiology

• • 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

Symptoms and Signs

• • Often asymptomatic

  • Mild dysphagia

  • Sense of pressure in neck or thorax

  • Gastroesophageal reflux

  • Chest pain

  • Cough

  • Dyspnea

  • Regurgitation

  • Upper GI bleeding

Imaging Findings

• • 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

• • 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

Rule Out

• • Carcinoma

• • Upper GI contrast study

  • Esophagoscopy with biopsy

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

When to Admit

• • Severe upper GI bleeding

  • Severe dysphagia prohibiting adequate enteral nutrition

• • Most small benign esophageal tumors can be removed endoscopically

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

Surgery

Indications

• • Inability to exclude carcinoma

  • All symptomatic lesions

  • All cysts

Treatment Monitoring

• • Interval endoscopy not indicated for excised lesions unless atypical

  • Interval endoscopy indicated for nonexcised, observed lesions

Complications

• • Hemorrhage

  • Obstruction

  • Regurgitation with aspiration

  • Respiratory distress

Prognosis

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