style="font-size: 10pt; font-family: Arial">Benign tumors and cysts of the esophagus are relatively uncommon and

can be studied using medical microscopes. From the perspectives of both the clinician and the pathologist using a

medical microscope, benign tumors may be divided into those that are within the muscular wall and those that are

within the lumen of the esophagus.

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Intramural lesions are either solid tumors or cysts, and

the vast majority are leiomyomas. These lesions are made up of varying portions of smooth muscle and fibrous tissue

which can be directly observed under a medical microscope. Fibromas, myomas, fibromy­omas, and lipomyomas are

closely related and occur rarely. Other histologic types of solid intramural tumors have been described, such as

lipomas, neurofibromas, hemangiomas, osteochondromas, granular cell myoblastomas, and glomus tumors, but they are

med­ical curiosities.

style="font-size: 10pt; font-family: Arial">Intraluminal lesions are polypoid or pedunculated growths that usually

originate in the submucosa, develop mainly into the lumen, and are covered with normal stratified squamous

epithelium when examined under medical microscopes. The majority of these tumors are composed of fibrous tissue of

vary­ing degrees of compactness with a rich vascular supply. Some are loose and myxoid like myxomas and

myxofibromas, some are more collagenous like fibromas, and some contain adipose tissue such as fibrolipomas. These

different types of tumor, usually studied under medical microscopes, are frequently collec­tively designated as

fibrovascular polyps, or simply as polyps. Pe­dunculated intraluminal tumors should be removed. If the lesion is

not too large, endoscopic removal with a snare is feasible.

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Leiomyoma

style="text-align: justify">Leiomyomas constitute more than 50%

of benign esophageal tu­mors. The average age at presentation is 38 years, which is in sharp con­trast to that

seen with esophageal carcinoma. Leiomyomas are twice as common in males. Since these tumors originate in the smooth

muscle, 90% are located in the lower two thirds of the esophagus. They are usu­ally solitary, but multiple tumors

have been found on occasion with the use of specialized medical microscopes. They vary greatly in size and shape.

Tumors as small as 1 cm in diameter and as large as 10 lb have been removed.

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Typically, leiomyomas are oval. During their growth, they remain intramural, having the bulk of their mass

protruding toward the outer wall of the esophagus. The overlying mucosa is freely movable and normal in appearance.

Neither their size nor location correlates with the degree of symptoms. Dysphagia and pain are the most common

complaints, the two symptoms occurring more frequently together than separately. Bleeding directly related to the

tumor is rare, and when vomiting blood or having blood tarry stools occurs in a patient with an esophageal

leiomyoma, other causes should be investigated.

style="text-align: justify">A barium swallow is the most useful

method to demonstrate a Leiomyoma of the esophagus. In profile, the tumor appears as a smooth, crescent-shaped

filling defect that moves with swallowing, is sharply demarcated, and is covered and surrounded by normal mucosa.

Esophagoscopy should be performed to exclude the reported observation of a coexistence with carcinoma. The freely

movable mass, which bulges into the lumen, should not be biopsied because of an increased chance of mucosal

perforation at the time of surgical removal of the entire tumor or enucleation.

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Despite their slow growth and limited potential for malignant de­generation, leiomyomas should be removed

unless there are specific contraindications. The majority can be removed by simple enucle­ation. If during removal

the mucosa is inadvertently entered, the defect can be repaired primarily. After tumor removal, the outer

esophageal wall should be reconstructed by closure of the mus­cle layer. The location of the lesion and the extent

of surgery re­quired will dictate the approach. Lesions of the proximal and middle esophagus require a right

thoracotomy, whereas distal esophageal lesions require a left thoracotomy. Videothoracoscopic approaches have been

reported. The mortality rate associated with enucleation is less than 2%, and success in relieving the dysphagia is

near 100%. Large lesions or those involving the gastroesophageal junction may require esophageal

resection.

style="font-size: 10pt; font-family: Arial">Esophageal Cyst

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class="MsoNormal" style="text-align: justify">Cysts may be

congenital or acquired. Congenital cysts are lined wholly or partly by columnar ciliated epithelium of the

respira­tory type, by glandular epithelium of the gastric type, by squamous epithelium, or by transitional

epithelium. In some, epithelial lin­ing cells may be absent. Confusion over the embryologic origin of congenital

cysts has led to a variety of names, such as enteric, bronchogenic, and mediastinal cysts. Acquired retention cysts

also occur, probably as a result of obstruction of the excretory ducts of the esophageal

glands.

Enteric and bronchogenic cysts are the most common and arise as a result of

developmental abnormalities during the formation and differentiation of the lower respiratory tract, esophagus, and

stomach from the foregut. During its embryologic development, the esoph­agus is lined successively with simple

columnar, pseudostratitied ciliated columnar, and finally stratified squamous epithelium. This sequence probably

accounts for the fact that the lining epithelium may be any or a combination of these; the presence of cilia does

not necessarily indicate a respiratory origin.

style="text-align: justify">Cysts, when observed under a

microscope, vary in size from small to very large, and are usually located intramurally in the middle to lower

third of the esophagus. Their symptoms are similar to those of a leiomyoma. The diagnosis similarly depends on

radiographic and endoscopic findings. Surgical excision by enucleation is the preferred treatment. During removal,

a fistulous tract connecting the cysts to the airways should be sought, particularly in patients who have had

repetitive bronchial and lung infections.