2. • 40 / M
• No comorbidities
• Epigastric pain associated with epigastric fullness
• Dysphagia to solids for 1 month
• Cough after food intake
• Dyspnoea on exertion
• ? Relevant H/O
20. CT report
A well defined, thin walled, large, nonenhancing, fluid
density lesion, measuring 13 mm x 11 mm x 9.1 mm in
the middle and posterior mediastinum, extending from T4
to T9 vertebrae and predominantly on the right.
The lesion is displacing the trachea anteriorly, the lower
two third of the esophagus to the ipsilateral side, and
causing splaying of the carina, main bronchi and right
pulmonary artery
The lesion is seen compressing upon the esophageal
lumen; fat planes between the lesion and the
esophageal wall is indistinct.
The lesion causes compression of the left atrium and
the pulmonary veins are stretched over the anterior
surface of the lesion, however the fat plane is preserved
44. Bronchogenic cyst
• MC cystic lesion
• Abnormal budding of the lungs
• MC in men/ right paratracheal location
• Symptoms of cough, substernal pain,
recurrent infections, dyspnoea
45. Esophageal duplication cysts
• Third most common benign esophageal mass
• MC – Leiomyoma
• 2nd
MC – Polyp
• Three criteria to establish diagnosis:
1.Esophageal attachment
2.Presence of 2 layers of muscularis propria
3.Epithelium characteristic of GI tract
48. • Pt was posted for Thoracotomy proceed
• He underwent excision of posterior
mediastinal tumor with resection of thoracic
esophagus + stomach pullup.
49. Findings
• 15 x 25x12 cm sized mass arising from the posterior
mediastinum ? site of origin with the oesophagus stretched
over it laterally and the tumour was crossing the midline.
• The lower limit was about 4 cm from the oesophageal hiatus.
• The tumour contained jelly like material and was infiltrating
the posterior pericardium.
• There were few enlarged nodes in relation to the tumour.
• The tumour was very vascular.
50.
51.
52.
53. Biopsy
• Smooth muscle tumor probably benign
• Leiomyoma
• Maximum tumor size – 11.2cm
• Tumor was adherent to wall of esophagus
55. Incidence
• Most common benign tumors of the
esophagus
• 90% occur in the lower/middle third
• Arise from muscularis mucosa
• Male predominance
56. • Most lesion are intramural/submucosal
• Solitary
• Size : 2-8cm
• Slow growing tumors
• 50% patients asymptomatic
57. Symptoms
• Dysphagia – Most common symptom
• Retrosternal pain/discomfort
• Heart burn
• Weight loss
58. Diagnosis
• UGI scopy : Submucosal mass lesion
• Barium swallow : Smooth filling defect in the
esophageal lumen without a mucosal
abnormality
• CT Thorax: Well defined eccentric intramural
mass with homogenous enhancement after
administration of IV contrast
59. • EUS : Homogenous and hypoechoic lesion
with clear margins with surrounding
hyperechoic area
60. • Biopsy : To be avoided
- Cause scarring and hampers extramucosal
excision of tumor
- Usually non diagnostic
61. Management
• Asymptomatic/ small leiomyomas
• Monitor periodically using UGI scopy, EUS and
CT thorax
• Risk of malignant transformation < 1%
64. Open approach
• Middle third of esophagus – Right
thoracotomy
• Lower third of esophagus - Left thoracotomy/
Left thoraco-abdominal / Transhiatal
approach
65. Summary
• Leiomyomas are rare tumors of esophagus
• If <5cm patient usually kept on follow-up
• Large leiomyomas are excised with segmental
esophageal resections
• Malignant potential <1%
