Esophageal Neoplasia

Benign Tumor

Leiomyoma, an intramural muscular tumor, is the most frequent benign neoplasm of the esophagus. It accounts for 75% of all benign esophageal neoplasms. Intraluminal tumors are very rare, and the majority of these lesions originate in the upper third of the esophagus and are generally benign polypoid tumors consisting of fibrous adipose and myxomatous material. They can be considered as fibrolipomas.

The majority of leiomyomas occur in the lower two-thirds of the esophagus where smooth muscle predominates. The leiomyomas generally have a fairly classic appearance on barium swallow and are quite smooth. On esophagoscopy, a bulge may be seen into the lumen of the esophagus, however, the mucosa of the esophagus is intact. The diagnosis should not be attempted by biopsies through the intact mucosa. This is unnecessary and undesirable since violation of the mucosa will make later enucleation of the mass much more difficult.

There is some justification for not resecting a benign leiomyoma; however usually there is a need to rule out malignancy. A thoracotomy is generally done and a myotomy performed with enucleation of the leiomyoma with preservation of the mucosa. A left thoracotomy at the sixth or seventh interspace is performed for low lesions while a right thoracotomy is preferable for more proximal lesions. If there is massive esophageal involvement, then conservative resection of the involved esophagus and end-to-end anastomosis is preferred. A cervical approach may be necessary for cervical esophageal leiomyomas.

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