Benign Esophageal Tumors

The clinical presentation of benign esophageal tumors vary widely and depend on the type. The majority are asymptomatic and are discovered incidentally. However, symptoms can include dysphagia, retrosternal or epigastric discomfort, bleeding, and/or weight loss.

• Barium esophagram or upper GI endoscopy

Initial evaluation typically mirrors that of dysphagia, beginning with a barium esophagram or upper GI endoscopy (with or without endoscopic ultrasound).

Once a lesion is visualized, tissue samples can be obtained with upper endoscopy.

A CT scan or MRI may be helpful in some cases for initial characterization, extent of involvement, and monitoring of changes over time.

• Surgical or endoscopic removal

Generally, treatment is recommended when benign tumors continue to enlarge or patients become symptomatic.

Leiomyoma, the most common benign esophageal tumor, may be multiple and can become large. Depending on its size and location, the tumor can be excised or enucleated. Minimally invasive approaches such as endoscopic submucosal dissection and video-assisted thoracoscopic surgery (VATS) have increasingly replaced open thoracotomy in many cases, thus reducing operative morbidity. With treatment, this tumor usually has an excellent prognosis (1).

Esophageal papillomas and granular cell tumors, although rare, may become malignant and their complete endoscopic removal is recommended.