Benign Esophageal Tumors

Benign Esophageal Tumors

Several tumors can arise from the different layers of the esophageal wall and may be benign, or noncancerous in nature. These are rare, however, and only comprise less than 1% of the tumors of the esophagus.  These benign tumors include Leiomyoma, Hemangioma, Granular cell tumor, Congenital esophageal cyst, Fibrovascular polyp, Bronchogenic cyst, Inflammatory fibroid polyp or Eosinophilic granuloma, Lymphangioma, Squamous cell papilloma, Lipoma, and Neurofibroma.  These tumors tend to cause no symptoms because they are slow-growing and are only noted incidentally during routine chest radiographs or during the evaluation of vague chest discomfort or difficulty in swallowing (dysphagia). 

Pathophysiology

Almost two thirds of the benign tumors of the esophagus is the Leiomyoma.  It arises from the muscular layer of the esophageal wall and is covered by the intact mucosa and submucosal layers and is usually found in the mid to lower portion of the esophagus.  Granulomas and inflammatory polyps can occur in the setting of esophagitis and can occasionally be confused with malignant lesions.

Epidemiology

Esophageal leiomyomas usually occur in people aged 20 to 50 years old.

Clinical Features

Majority of the benign esophageal tumors have no presenting symptoms and can go undetected for several years.  However, large or strategically located tumors may become symptomatic and cause dysphagia or difficulty in swallowing, odynophagia (pain in swallowing), chest pain or discomfort, food regurgitation, and weight loss.  Other symptoms may include cough, difficulty breathing, or sore throat.  There have been reported cases where Leiomyomas outgrew their blood supply, causing ulceration and bleeding.

Diagnosis

Esophageal tumors can be visualized with barium swallow and esophageal ultrasonography.  Esophagoscopy, an endoscopic procedure, would also be able to rule out a carcinoma by obtaining tissue samples for biopsy.

Treatment

Small esophageal tumors not causing any symptoms are managed expectantly and are followed up periodically using barium swallow.  These tumors, especially Leiomyomas, have a slow growth rate and are not at risk for transformation into malignancy. 

Surgical resection is recommended for tumors causing symptoms and complications, and for large tumors measuring more than 5cm.  Open surgical technique is the recommended management for esophageal tumors, although combined esophagogoscopy and video-assisted resection or thoracoscopy can alternatively be performed. 

Prognosis

Prognosis is good for benign esophageal tumors because they do not recur following complete surgical resection.

Summary References

Treatments:
1. http://www.merck.com/mmpe/sec02/ch021/ch021b.html?qt=Benign%20Esophageal%20Tumors&alt=sh

2. http://www.ncbi.nlm.nih.gov/pubmed/11965474

3. http://www.semthorcardiovascsurg.com/article/S1043-0679%2803%2970039-2/abstract

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