Editing Benign oesophageal tumours


== '''Pathophysiology''' ==

* Benign tumours more commonly     occur in submucosa and muscularis propria than in the mucosa

== '''Mucosal     tumours''' ==

=== '''Granular      cell tumours''' ===

*** Found in skin, respiratory       tract, GIT, breast, tongue
*** 11% of patients have       multiple tumours
*** Derive from Schwann cells       (nerve sheath origin)
*** Can also occur in submucosa
*** Distal third of oesophagus       is most common location in GIT
**** Sessile or bulging        whitish-grey lesions with often normal-appearing mucosa
*** Standard biopsies often       non-diagnostic due to overlying epithelium. Tunnelled biopsies reveal       eosinophilic granules.
*** 98-99% are benign
*** Indications for excision:       atypical features on EUS, size >2cm, presence of symptoms
*** Generally excise       endoscopically
***

=== '''Fibrovascular      polyps''' ===

*** Mostly found in cervical       oesophagus at or near the cricopharyngeus
*** Cylindrical or elongated,       with a stalk
*** Symptoms are rare
*** Can resect endoscopically       if needed

=== '''Squamous      papillomas''' ===

*** Most often found in distal       oesophagus
*** Usually associated with       underlying inflammation, and possibly HPV
*** Colourless, exophytic,       wart-like projections
*** Often seen with a crossing       vessel on the surface
*** Excise completely to rule       out carcinoma
***

== '''Submucosal     tumours''' ==

=== '''Lipoma''' ===

*** Homogenous, hyperechoic,       smooth appearance on EUS
*** Symptoms rare
*** Resection seldom needed
***

=== '''Haemangioma''' ===

*** Purple or reddish nodule
*** EUS - smooth, hypoechoic,       submucosal mass
*** Mostly asymptomatic
*** Can cause dysphagia or       bleeding
*** If symptomatic, can be       treated endoscopically
***

=== '''Neural      tumour''' ===

*** Neurofibroma, schwannoma
*** Rare in oesophagus
*** Commonly seen in upper       oesophagus
*** Yellow-white-tan rubbery       lesions with glistening smooth surface
*** Majority benign, but can       transform into malignant schwannoma
*** Symptomatic tumours can be       enucleated endoscopically
*** Large tumours may require       oesophagectomy

== '''Muscularis     propria tumours''' ==

=== '''Leiomyoma''' ===

*** Most common benign tumour       of oesophagus
*** Arises from muscularis       propria, although very rarely can arise from muscularis mucosae
*** 2:1 male predominance
*** Usually asymptomatic
*** Usually found in mid to       distal oesophagus - more smooth muscle there
*** Round protrusion into the       lumen of the oesophagus with smooth, normal mucosa
*** EUS - hypoechoic, regular       borders, arise from the fourth endosonographic layer
*** Small asymptomatic       suspected leiomyoma can be observed without biopsy
*** Don't biopsy if suspected       based on EUS - will complicate attempts to enucleate subsequently, by       scarring up the layers
*** Symptomatic lesions can be       enucleated
*** Larger lesions can be       removed via VATS or endoscopically - endoscopic resection with creation       of a submucosal tunnel for leiomyomas up to 5.5cm
***

== Presentation ==

* Mostly asymptomatic

== Investigation ==

* Barium swallow - smooth     defect in the lumen
* Gastroscopy
* CT

== Differential diagnosis (see 'oesophageal cancer' topic) ==

* Leiomyosarcoma
* GIST

[[Category:UGIS]]