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Benign Oesophageal Tumours

  • Benign oesophageal tumours are rare
  • Grow slowly like a balloon by expansion, compressing surrounding structures
  • Never infiltrates or spreads
  • Can be solid, cystic, polypoid
  • Can lead to obstruction, regurgitation, aspiration, mediastinal compression
  • Types – squamous papilloma, polyp, inflammatory pseudotumour, leiomyoma (most common), neurofibroma, lipoma
  • Clinical features – asymptomatic, dysphagia, airway obstruction, pneumonia, spluttering during swallowing, regurgitation

Leiomyoma – most common

  • Benign smooth muscle tumour
  • Smooth, sessile , lobulated, firm, grey-white whorled appearance
  • Only causes obstruction when >5cm
  • True diffuse LM occasionally occur in females in lower oesophagus
    • Diffuse hyperplasia and thickening of both muscular layers
    • Often occurs as part of Alport’s syndrome – requires total oesophagectomy with gastric pull up
  • Leiomyoma which expresses the c-kit oncogene (CD117) – considered as GIST
  • Clinical features
    • Small tumours (<5 cm) – asymptomatic
    • Large tumours – dysphagia, regurgitation, oesophageal obstruction, chest pain, cough, or bleeding
  • Investigations – barium swallow, oesophagoscopy, endosonography, CT
  • Treatment
    • If tumour >5cm/symptomatic/doubtful diagnosis
    • Enucleation is treatment of choice – can be minimally invasive ( VATS) or through thoracotomy

    • Oesophageal cysts

    • 2nd most common benign tumour of the oesophagus
    • Congenital cyst – from foregut
      • Lined by ciliated columnar epithelium
      • Contains mucous
      • Common in infants
      • Found in upper third of oesophagus – can form fistula into airway, causing obstruction
    • Acquired cyst – from obstruction of the excretory ducts of oesophageal glands
    • Treatment – enucleation or resection
      • if fistula present, it should be ligated and divided
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