This is the easy note about benign tumor of the esophagus

1. Benign Esophageal Tumors and
Cysts
Dr. K Khaing Saw Lwin

2. • Uncommon
• <1 % of esophageal neoplasms
• EUS essential for diagnosis

3. EUS
• provides definition of the esophageal wall and
periesophageal tissue (not possible to obtain with
routine scopy)
• Ultrasound endoscopes scan the wall with
ultrasound waves of 5 to 12 MHz
• FIVE alternating layers of different echogenicity
• Uses - evaluating abnormalities of the esophageal wall
- diagnosing nonmucosal esophageal tumors
- small probe – can assess the lumen of esop stricture

7. Tumors of Mucosa
Symptoms Dx & Tx Association
Squamous
Papilloma
-small (<1 cm),
solitary, sessile
projections
-Distal esophagus
-Incidentally -DxOGDS
-Endoscopic excision
-Mnt change rare
-HPV and
GERD
Fibrovasc
ular
polyps
- collections of
fibrous, vascular,
and adipose
tissue lined by
normal squamous
epithelium
-cervical
esophagus
esophageal
lumen, may reach
into the stomach
- Dysphagia,
respiratory -/s,
-Dx Barium/OGDS
-Excision

9. Submucosa
Tumor
Endoscopy EUS -/S, DX,Tx
Lipoma -Bulging of eso mucosa
-Pale yellow,soft or pillow
like texture
Bx- N squamous epi (cant
penetrate submucosa)
- hyperechoic
homogeneous lesion that
originates in and is
confined to the
submucosal layer
-
AsymptomaticObs
eravation
- Mnt change rare
Fibroma,
Neurofibroma
- Firm to touch -less hyperechoic by EUS
than are lipomas
- Symptomatic 
enucleated with
minimal invasive
technique
Granular cell
tumor
-yellow, firm nodules,
-Dx-endoscopic biopsies
(nests of cells with pyknotic
nuclei, abundent cytoplasm,
absence of mitosis, strong S-100
expression)
-arise from submucosa,
hyperechoic, but less
than
lipomas
-Neural origin
(Schwann cells)
-Asymptomatic
-Malignant variant
(+)
Hemangioma -Looks like esophageal
varices (lower oeso)
-hypoechoic mass with
sharp margins arising
from the second or third
EUS layer
-Dysphagia,bleeding
Tx -observation,
simple excision,
fulgarization,
or radiotherapy.

11. Tumors of muscularis propria
• Leiomyoma
- Benign smooth muscle tumor
- Most common (70% of Benign eso tumor)
- Age – Younger patient
- M= F
- Most arise from the inner circular muscle layer
of the distal and midthoracic esophagus

12. Leiomyoma
• Asymptomatic
• -/S  dysphagia, pain , bleeding
• -/S  distal tumor asso GERD

13. • Barium esophago smooth-contoured filling defects
• Esophagoscopy and EUS a normal overlying mucosa
is seen over a hypoechoic tumor arising from the
fourth ultrasound layer
• Atypical EUS findings
-tumor 4 cm or larger,
-irregular margins
-mixed internal echo characteristics,
-associated regional lymphadenopathy
Bx can’t diff b/t leiomyoma & leiomyosarcoma

14. • asymptomatic tumors with typical EUS features
expectant therapy and EUS observation
• Symptomatic  removal
• DDx
• Leiomyosarcoma
• GISTs (originate from GI pacemaker cells of Cajal,
stain positively for tyrosine kinase and should be
excised by esophagectomy)

16. Esophageal Cysts
• 2nd most common (20% of benign eso tumor)
• Congenital Foregut cyst ( Major)
• Acquired epithelial cyst

17. Acquired
Epithelial cysts
- Arise in lamina propria
- D/t submucosal glandular inflammation
Congenital
foregut cysts
- lined with squamous, respiratory,
or columnar epitheli,may contain smooth muscle,
cartilage, or fat
-ESOPHAGEAL DUPLICATION CYST
#lined with squamous epithelium,
submucosal and muscularis elements interdigitate
with the muscularis propria of the esophagus
#associated with vertebral and spinal
cord abnormalities
-EUS the intramural or
extraesophageal nature,
anechoic,
cystic nature
Suggestionremoval of
all discovered cysts
(most become
symptomatic by
adulthood)

19. Thank you