Benign Esophageal Tumors Research Articles

Minimally Invasive Surgical Enucleation or Esophagogastrectomy for Benign Tumor of the Esophagus

Experience in surgical resection of benign tumor of the esophagus is limited. Authors performed a chart review of 5 patients who underwent minimally invasive surgical resection of benign esophageal tumor. Main outcome measures included operative approaches, tumor's location and size, and outcomes. Tumor location were middle esophagus (n = 1), distal esophagus (n = 2), and gastroesophageal junction (n = 2). There were 4 females with a mean age of 55 years. Surgical approaches included thoracoscopic enucleation (n = 1), laparoscopic enucleation (n = 1), and laparoscopic and thoracoscopic Ivor Lewis esophagogastrectomy (n = 3). There were no open conversions. Mean operative time for enucleation was 127 minutes and 240 minutes for Ivor Lewis esophagectomy. Mean hospital stay was 5.8 days. There were no major or minor complications. Three patients developed stomal stenosis. The 30-day mortality was zero. Surgical pathology showed leiomyoma in 3 patients and gastrointestinal stromal tumor in 2 patients. Tumor size ranged from 1.1 to 10.5 cm. There has been no tumor recurrence at a mean follow-up of 14 months. Minimally invasive surgical enucleation or esophagogastrectomy for benign esophageal tumor is feasible and safe. The optimal approaches should be tailored based on the location and size of the tumor.

Robotic Extirpation of Complex Massive Esophageal Leiomyoma

Esophageal leiomyomas are the most common benign mesenchymal esophageal tumors, but they occur rarely in the pediatric population. Leiomyomas are conventionally treated with extramucosal enucleation via an open thoracotomy. In this paper, we report a case of a complex massive retrocardiac esophageal leiomyoma that was successfully extirpated by using a robotic-assisted thoracoscopic technique. Intraoperative esophagoscopy and transillumination were useful adjuncts in identifying the esophagus and developing a safe extramucosal dissection plane.

Minimally Invasive Therapy for Benign Tumors of the Distal Third of the Esophagus—A Single Institute's Experience

Traditionally, the treatment of benign esophageal tumors is enucleation achieved via a thoracotomy. Since 1992, many reports of thoracoscopic and laparoscopic approaches have been published. In this paper, we present a retrospective study of 18 patients with benign distal esophageal tumors who underwent minimally invasive procedures. A total of 18 patients were treated in our institute form 1994 to 2006. Tumors of the middle third were approached thoracoscopically, and laparoscopic transhiatal enucleation was performed for tumors of the lower third. One patient had associated achalasia cardia, for which a cardiomyotomy with Toupet fundoplication was also performed, and another patient underwent an esophagectomy for a large tumor. There were 12 males and 6 females and the average age was 59 years. The majority of the tumors were in the lower third, and the most common type of tumor was leiomyoma. Postoperative complications were recorded. Leiomyomas are the most common benign tumors and are located frequently in the middle and lower third. Based on our experience, we feel that lower esophageal tumors are best approached by a laparoscopic transhiatal route and midesophageal tumors by a right thoracoscopic approach. Minimally invasive surgery for benign esophageal tumors is ideal, reducing the morbidity of conventional methods.

Dedicated multi-detector CT of the esophagus: spectrum of diseases

Multi-detector computed tomography (CT) offers new opportunities in the imaging of the gastrointestinal tract. Its ability to cover a large volume in a very short scan time, and in a single breath hold with thin collimation and isotropic voxels, allows the imaging of the entire esophagus with high-quality multiplanar reformation and 3D reconstruction. Proper distention of the esophagus and stomach (by oral administration of effervescent granules and water) and optimally timed administration of intravenous contrast material are required to detect and characterize disease. In contrast to endoscopy and double-contrast studies of the upper GI tract, CT provides information about both the esophageal wall and the extramural extent of disease. Preoperative staging of esophageal carcinoma appears to be the main indication for MDCT. In addition, MDCT allows detection of other esophageal malignancies, such as lymphoma and benign esophageal tumors, such as leiomyma. A diagnosis of rupture or fistula of the esophagus can be firmly established using MDCT. Furthermore, miscellaneous esophageal conditions, such as achalasia, esophagitis, diverticula, and varices, are incidental findings and can also be visualized with hydro-multi-detector CT. Multi-detector CT is a valuable tool for the evaluation of esophageal wall disease and serves as an adjunct to endoscopy.

Minimally invasive resection of benign esophageal tumors

Benign tumors of the esophagus are uncommon. Traditionally, resection has required thoracotomy or laparotomy. In this study we present our experience with resection of these tumors using a minimally invasive approach. A retrospective review of patients who underwent resection of benign esophageal tumors between 1990 and 2005 was conducted. Operative approach, tumor size, and outcomes after surgery were recorded. Twenty patients were identified (leiomyoma: n = 15; stromal tumor: n = 3; granular cell tumor, n = 1; schwannoma: n = 1). Four patients underwent an open approach (right thoracotomy); the remainder were resected using minimally invasive techniques (thoracoscopy, n = 9; laparoscopy, n =7). There were no postoperative leaks or other major complications after surgery. Two patients required repair of a mucosal injury during resection. Mean tumor size in the open group was 8.1 cm (range 7-10 cm) compared with 3.5 cm (range 0.9-8 cm) in the minimally invasive group. Median length of stay was 5.5 days in the open group compared with 2.75 days in the minimally invasive group. Five patients subsequently required fundoplication for worsening (n = 3) or new-onset (n = 2) gastroesophageal reflux disease after tumor resection. Minimally invasive resection of benign esophageal tumors is technically safe and associated with a shorter length of stay compared with open approaches. Although no specific cutoff for size could be identified, most tumors greater than 7 cm were removed by thoracotomy. The subsequent development of reflux may be related to the esophageal myotomy required for resection.

Thoracoscopic management of benign tumors of the mid-esophagus: A retrospective study

Benign esophageal tumors are rare conditions. Traditionally, thoracotomy was the preferred route to approach these lesions. Now, increasingly more surgeons are using minimally invasive techniques to treat these benign mid-esophageal lesions. We present our experiences from a specialised minimally invasive surgery unit. We have managed 12 patients with benign tumors of the mid-esophagus from 1995 to 2007 in our institute. The enucleation was achieved with the patient placed in the prone position and approached via a right thoracoscopy in all cases. Hospital stay was 3–5 days and there were minor postoperative complications in 2 patients. Mortality was nil. There were 10 patients with leiomyoma and 2 with GISTs, as proved by immunohistochemistry. Short and long-term follow up was satisfactory, with none of the patients having recurrences or other problems. Leiomyomas and GISTs, respectively, are the commonest benign tumors of the esophagus. Tumors more than 5 cm have to be enucleated, and thoracotomy has been the traditional approach to these lesions. Thoracoscopy has definite benefits regarding reduced morbidity. The combined modality of peroperative endoscopy is useful in locating the lesion as well as confirming its complete removal. Based on our experience, a right thorax approach and the prone patient position is the ideal for thoracoscopic procedures.

Giant fibrovascular polyp of the esophagus: MRI is useful for diagnosis and surgical planning

In the surgical field, benign esophageal tumors are much more uncommon than esophageal malignancies. In particular, fibrovascular polyps of the esophagus are extremely rare. We present a case involving a giant fibrovascular polyp (22 cm × 9 cm) in which not only location and site of origin but also precise polyp type were diagnosed preoperatively using magnetic resonance imaging (MRI). The lesion was then resected safely using a cervical approach. MRI is useful for acquiring valuable information about fibrovascular polyps. This case demonstrates the utility and safety of transcervical esophagotomy in the treatment of giant fibrovascular polyp of the esophagus.

Giant fibrovascular polyp of the esophagus

Giant fibrovascular polyps are uncommon benign esophageal tumors almost always originating from the cervical esophagus, frequently from the upper esophageal sphincter. The case of a 74-year-old man with a long history of dysphagia and a weight loss of 9 kg is presented. Neither barium esophagogram, computed tomogram or magnetic resonance imaging correctly evidenced the lesion. Only fiberoptic endoscopy suggested the correct diagnosis because the mass fluctuated endoluminally with the spasm of vomiting. A left cervical exploratory incision with esophagotomy was performed following the experience of two previous similar cases. A giant fibrovascular polyp was observed and excised. If a malignant or benign extensive intramural tumor had been identified, a total esophagectomy would have been performed. In our opinion the possibility of the presence of a fibrovascular polyp should always be considered in the presence of an undetermined esophageal mass, and in these cases a left cervical incision is the preferred surgical access. Once the correct diagnosis is established, a major esophageal resection should always be avoided.

Diseases of the Esophagus: Diagnosis with Esophagography

The barium esophagram is a valuable diagnostic test for evaluating structural and functional abnormalities of the esophagus. The study is usually performed as a multiphasic examination that includes upright double-contrast views with a high-density barium suspension, prone single-contrast views with a low-density barium suspension, and, not infrequently, mucosal-relief views with either density of barium suspension. The double-contrast phase optimizes the ability to detect inflammatory or neoplastic diseases, whereas the single-contrast phase optimizes the ability to detect hiatal hernias and lower esophageal rings or strictures. Fluoroscopic examination of the esophagus is also important for assessing motility disorders such as achalasia and diffuse esophageal spasm. This article is a review of gastroesophageal reflux disease, other types of esophagitis, benign and malignant esophageal tumors, varices, lower esophageal rings, diverticula, and esophageal motility disorders, all of which can be diagnosed with the aid of esophagography.

Giant fibrovascular polyp of the esophagus—Case report

Benign tumors of the esophagus are uncommon and are usually diagnosed only when their size induces dysphagia. In large autopsy series, benign esophageal tumors were detected in about 0.5% of cases2. Benign esophageal tumors may be classified as intraluminal, intramural or extramural. Benign intraluminal tumors are far less common and include fibrovascular polyp, hamartoma, lymphangioma, squamous papilloma and lipoma3. The fibrovascular polyp is the most common intraluminal nonepithelial tumor which accounts for 0.51% of all benign esophageal tumors4,5. Indeed, although the dramatic presentation of these polyps has resulted in at least 25 individual patients reported in the English literature between 1969 and 2003, only a single case series of 16 FVPs has been compiled, from cases seen at the Armed Forces Institute of Pathology6. Giant FVPs are slow-growing, pedunculated masses that usually arise from the upper third of the esophagus, near the level of the cricopharyngeus, and are covered Address for correspondence: Dr. Ahmet Bayram, MD, Department of Thoracic Surgery of Uludag University Medical Faculty, Gorukle Bursa, Turkey 16059 Tel: +90 224 4429166 Fax: +90 224 4428698 Email: asbayram@yahoo.com @ IJTCVS 097091342020604/59 Introduction

Benign esophageal tumors: Introduction, incidence, classification, and clinical features

Benign esophageal tumors comprise a diverse group of disorders that are rare in relation to malignant tumors or other benign conditions. The current article summarizes the literature with regard to the incidence and prevalence of benign tumors of the esophagus and discusses the various methods used to categorize these conditions. Summaries of important clinical features are provided for leiomyomas, esophageal cysts, fibrovascular polyps, papillomas, granular cell tumors and others. © 2003 Elsevier Inc. All rights reserved.

Benign esophageal tumors: Esophagoscopy and endoscopic esophageal ultrasound

Benign esophageal tumors are uncommon. Flexible fiberoptic esophagoscopy (esophagoscopy) has improved detection but is ineffective in classification of extramucosal tumors. Endoscopic esophageal ultrasound (EUS) is vital in diagnosis. Small lesions that have either a homogeneous anechoic, intermediate, or hyperechoic pattern are almost exclusively benign. These findings, plus the determination of the layer of origin within the esophageal wall, permit precise and accurate noninvasive diagnosis. The diagnosis of a benign esophageal tumor by esophagoscopy and EUS in an asymptomatic patient requires, at most, surveillance but no therapy. © 2003 Elsevier Inc. All rights reserved.

Treatment of benign esophageal tumorsby endoscopic techniques

Gastrointestinal endoscopy has changed in recent years from a largely diagnostic to a highly therapeutic procedure. Technical advances in endoscopic ultrasound as well as new devices designed for endoscopic mucosal resection (EMR) have opened the field to many therapeutic possibilities. Endoscopic resection is technically challenging, and while our colleagues in the Far East have been using such techniques for over a decade, EMR in the West is still in its infancy. The decision to resect a benign esophageal tumor must take several factors into account including whether the patient is symptomatic; characteristics of the particular tumor (including the potential for malignant transformation, risk of bleeding, and obstruction); and the available therapeutic options. Endoscopic resection of benign esophageal tumors is an attractive option as it is a safe and minimally invasive procedure. Its use is limited, however, to smaller tumors arising from the mucosal or submucosal layers. In this article we examine the techniques used in endoscopic mucosal resection and review the literature on this subject. © 2003 Elsevier Inc. All rights reserved.

Minimally invasive techniques for resection of benign esophageal tumors

With the emergence of minimally invasive surgery (MIS), laparoscopy and thoracoscopy have become feasible and safe alternatives to open surgical procedures in the management of esophageal leiomyomas. The indications for MIS resection of leiomyomas at our institution include the presence of symptoms, confirmation of pathology to exclude malignancy, tumors greater than 2 cm in size or tumors that show evidence of growth. Our approach of choice is right video-assisted thoracoscopic surgery (VATS) for tumors of the thoracic esophagus and laparoscopy for tumors of the intra-abdominal esophagus or gastroesophageal junction. A detailed description of these surgical approaches is outlined in the following chapter. At our institution, nine patients, 8 males and 2 females with a mean age of 54 years (range 42-67 years) had a minimally invasive surgical resection of an esophageal leiomyoma between 1995 and 2001. The surgical approaches included right VATS enucleation (6) and laparoscopic enucleation (3). There were no major morbidities, including postoperative leaks or mortalities. The mean hospital stay was 2.3 days. All tumors were benign leiomyomas with average size of 2.73 cm (range 0.9-8 cm) and there was no evidence of recurrence at a mean follow-up of 10 months. Video-assisted enucleation has shown in our institution, as well as in others, that the procedure can be performed safely with low mortality and morbidity. A VATS or laparoscopic approach to the removal of leiomyomas should be the treatment of choice in centers experienced in minimally invasive surgery. © 2003 Elsevier Inc. All rights reserved.

Long-term (> 5 yr) follow-up of endosonographically benign tumors of esophagus or stomach by questionnaire and repeated EUS.

s of the Netherlands Society of Gastroenterology and the Netherlands Society of Hepatology: Spring Meeting, 15–16 March 2001

Giant polypoid tumor of the esophagus

A patient with a giant polypoid tumor of the esophagus, measuring 22 cm in length is described in this report. The patient presented with cough attacks and respiratory distress. Diagnostic and therapeutic intervention required aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Benign esophageal tumors are rarely seen and originate from the upper third of esophagus, frequently close to the cricopharyngeus muscle. They may attain giant proportions. A variety of clinical presentations are described, the most serious being asphyxia secondary to laryngeal obstruction [1]. We observed a giant esophageal tumor which was interpreted as angiofibromyolipoma that caused laryngeal obstruction. We present the clinical picture and histopathological findings of the tumor.

Tumors of the esophagus.

This collective review includes all available case reports of smooth muscle (stromal) tumors of the esophagus in the world literature. Compiling this review, we endeavored to examine cumulative and recently collected data of both benign and malignant esophageal smooth muscle tumors found in the literature spanning the period from 1875 to 1996, which totaled 1679 leiomyomas (LMs) and 165 leiomyosarcomas (LMSs). The peak age of occurrence of benign smooth muscle tumors in the esophagus was found to be between the ages of 30 and 59, whereas the highest frequency of malignant tumors was seen later in life, during the decade from age 60 to 69. The most common location of both LMs and LMSs was the lower third of the esophagus. Their patterns of growth differed; LMs were more likely to grow intramurally, and LMSs were predominantly intraluminal. Most patients with LMs presented with dysphagia and pain or discomfort; patients with LMSs additionally commonly complained of weight loss. As with smooth muscle tumors of other areas of the gastrointestinal tract, the duration of symptoms averaged 1 month to 1 year, and malignant tumors grew to larger sizes than benign neoplasms. Approximately one-third of LMSs had metastasized at diagnosis, and there was a 5-year survival rate of approximately 20%.

頚部食道リンパ管腫の１例

Among benign esophageal tumors, leiomyoma is the most frequently seen and lymphangioma is extremely rare. This article reports a case of lymphangioma arising in the cervical esophagus.A 74-year-old man complained of mild swallowing difficulty. Esophageal fiberscopic examination showed a submucosal soft mass with an apparently preserved overlaying mucosa in the cervical portion of the esophagus. MRI revealed a low intensity area on T1-weighted, and a high intensity area on T2-weighted images. The tumor was not enhanced on the T1-weighted image with gadolinium contrast.The tumor was successfully removed under direct esophagoscopic control without any complications. Lymphangioma was diagnosed by histopathological examination. Postoperatively, the symptoms were resolved, and the patient has remained asymptomatic for 1 year and 10 months.

A Case of Esophageal Cyst Excised Successfully Using Laparoscopy

Abstract:Laparoscopic excision of an esophageal cyst was successfully performed on a 29‐year‐old male. The patient, complaining of back pain, was admitted to our hospital for further evaluation of a submucosal esophageal tumor. Close examination revealed a cystic tumor originating from the proper muscular layer at the distal esophagus, measuring 3 cm in diameter. Under general anesthesia, the tumor was excised laparoscopi‐cally without esophageal mucosal injury, with monitering by esophagoscopy. Postoperative esophagography showed no stagnation or stenosis. He was discharged on the 11th postoperative day. The cyst was diagnosed pathologically as an inclusion cyst of the esophagus. Laparoscopic or thoracoscopic surgery is a useful treatment for benign esophageal tumors, because it is less invasive giving more rapid recovery. Concomitant esophagoscopic monitering is beneficial to avoid injury of the esophageal mucosa, especially in such benign tumors that are firmly adherent to the esophageal muscle and mucosal layer.

Alport Syndrome with Diffuse Leiomyomatosis: When and When Not?

Alport Syndrome with Diffuse Leiomyomatosis: When and When Not?