Solid benign tumors of the esophagus

An analytical and comparative study of swallowing in a tumor-infected oesophagus: a mathematical model

This study discusses non-steady effects encountered in peristaltic flows in oesophagus. The purpose of this communication is to evolve a mechanism to diagnose tumor in an oesophagus mathematically. The tumor is modelled by generic bump function of certain height and width. The method of solution follows long wavelength and low-Reynolds number approximations for unsteady flow, while integrations have been performed numerically in order to plot graphs, which reveal various characteristics of the flow. The goal is to assess how pressure varies across the tumor's width. The spatial, as well as temporal, dependence of pressure has been studied in the laboratory frame of reference. The pressure distribution for tumor-infected oesophagus is compared with that of normal oesophagus. An intensified pressure is obtained in the presence of tumor. The interruption while swallowing through benign oesophageal tumor is confirmed by an abrupt pressure rise across the tumor's width. Tumor position also plays a significant role whether it is at contraction or relaxation of walls. Additionally, wall-shear-stress, volumetric flow rate and streamlines have also been described and compared with that without tumor growth. The expressions corresponding to all the physical quantities are computed numerically. Further, this model may also be implemented to the two-dimensional channel flow for an industrial application.

Video-Assisted Thoracoscopic Surgery for Esophageal Leiomyoma: A Ten-Year Single-Institution Experience

OBJECTIVE

This study was a 10-year single-institution experience with surgery for esophageal leiomyomas comparing a minimally invasive approach to thoracotomy.

MATERIALS AND METHODS

A retrospective review of patients who underwent resection of esophageal leiomyomas between 2008 and 2017 was conducted. Information on demographic features, symptoms, the operative approach, and complications was recorded.

RESULTS

Fifty-six patients were enrolled. Forty patients underwent an open surgical approach, and 16 patients were treated using thoracoscopy. There was no postoperative mortality or esophageal leakage. Five patients required the repair of a mucosal injury during resection. There were no statistically significant differences in operative time, blood loss, chest tube duration, or the length of postoperative stay between the video-assisted thoracoscopic surgery (VATS) group and the thoracotomy group. The mean tumor size in the thoracotomy group was larger than that in the VATS group (3.63 ± 2.15 versus 2.23 ± 1.30, P = .01).

CONCLUSIONS

Thoracoscopic enucleation is a safe and effective treatment for esophageal leiomyoma.

Laparoscopic approach in the treatment of large leiomyoma of the lower third of the esophagus

Leiomyoma of the lower third of the esophagus is a relatively rare disorder but the most common benign tumor of the esophagus. We present a case of an involuted esophageal leiomyoma, 11 cm in size, treated by the laparoscopic approach. The preoperative computed tomogram visualized a mass 3 × 1.5 cm in diameter in the lower esophagus without an eccentric lumen or compression of nearby organs. Resection of the tumor was indicated according to the patient‘s symptoms and to exclude malignancy. Laparoscopic enucleation of esophageal leiomyoma was performed. The overall operative time was 205 min. The diagnosis of leiomyoma was established on histopathology and immunohistochemistry staining. The patient resumed the intake of a normal diet on the 5^th postoperative day and was discharged from hospital 8 days after the surgery. We have found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon.

Benign esophageal tumors

Benign esophageal and paraesophageal masses and cysts are a rare but important group of pathologies. Although often asymptomatic, these lesions can cause a variety of symptoms and, in some cases, demonstrate variable biological behavior. Contemporary categorization relies heavily on endoscopic ultrasound and other imaging modalities and immunohistochemical analysis when appropriate. Minimally invasive options including endoscopic, laparoscopic, and thoracoscopic methods are increasingly used for symptomatic or indeterminate lesions.

Endoscopic mucosal resection of large hyperplastic polyps in 3 patients with Barrett’s esophagus

AIM: To report the endoscopic treatment of large hyperplastic polyps of the esophagus and esophago-gastric junction (EGJ) associated with Barrett’s esophagus (BE) with low-grade dysplasia (LGD), by endoscopic mucosal resection (EMR).

METHODS: Cap fitted EMR (EMR-C) was performed in 3 patients with hyperplastic-inflammatory polyps (HIPs) and BE.

RESULTS: The polyps were successfully removed in the 3 patients. In two patients, with short segment BE (SSBE) (≤ 3 cm), the metaplastic tissue was completely excised. A 2 cm circumferential EMR was performed in one patient with a polyp involving the whole EGJ. A simultaneous EMR-C of a BE-associated polypoid dysplastic lesion measuring 1 cm x 10 cm, was also carried out. In the two patients, histologic assessment detected LGD in BE. No complications occurred. Complete neosquamous re-epithelialization occurred in the two patients with SSBE. An esophageal recurrence occurred in the remaining one and was successfully retreated by EMR.

CONCLUSION: EMR-C appears to be a safe and effective method for treating benign esophageal mucosal lesions, allowing also the complete removal of SSBE.

Adenoma of the esophagus with intracytoplasmic mucoid bodies

We report a tubular adenoma of the esophagus in a 79-year-old man. The tumour had progressed to an intramucosal carcinoma at follow-up 6 months later. The adenoma displayed a peculiar and heterogeneous histological picture with non-dysplastic and cystic areas alternating with those of a typical tubular adenoma. The tumour revealed a strong and diffuse expression of cytokeratin 7 and basal cell cytokeratin, whereas cytokeratin 20 was focally positive only. The most remarkable finding, however, was the demonstration of intracytoplasmic inclusion-like mucoid bodies of the epithelial cells in a small area of the adenomatous component. These inclusions stained PAS positive and alcian blue negative, and electron microscopy revealed a homogeneous structure without viral-like particles.

Treatment of benign esophageal tumors by 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.

Case report: lymphangioma of the oesophagus endoscopically resected

Lymphangioma of the oesophagus is an extremely rare entity, with only nine cases having been reported worldwide. We report on a 52-year-old woman with oesophageal lymphangioma, diagnosed using endoscopic ultrasonography and endoscopically resected. No case of malignant transformation of the lymphangioma has been reported in the literature. Endoscopic resection seems to be a minimally invasive method that is appropriate both for the removal of the tumour and precise diagnosis.

Esophageal leiomyoma in children: two case reports and review of the literature

Leiomyoma of the esophagus is not uncommon in the adult population but is rarely seen in children; only 20 cases have been reported in the pediatric population. In this paper we describe two cases of esophageal leiomyoma in female patients aged 6 and 13 years and review previous reports. Several differences were noted between the pediatric and adult population. The mean age in children is 14 years (range, 4 to 20 years). Leiomyoma appears 1.71 times more often in females than in males. Localized lesions are found in only 9%, whereas the diffuse form predominates in 91%. The entire esophagus may be involved 35% of the time, and encroachment on the cardia or upper stomach occurs in 70%. Leiomyomas associated with familial syndromes (familial leiomyoma and Alport's syndrome) occur in 22% of the cases. Major symptoms include dysphagia (86%), dyspnea (36%), vomiting (27%), retrosternal pain (27%), and coughing (22%). The initial diagnosis following contrast studies is most often achalasia. The diagnosis of leiomyoma is made only with subsequent endoscopy. Enucleation was performed in only 11% of the cases; surgical resection (including part of the stomach) was necessary in 78% with a 21% postoperative mortality. Esophageal leiomyoma should be considered in the differential diagnosis of mediastinal masses and esophageal obstruction. Accurate preoperative diagnosis is desirable in order to plan proper surgical treatment.

Giant intraluminal polyps of the esophagus

Giant intraluminal polyps of the esophagus are relatively rare. Their diagnosis often presents a confusing picture; radiographic studies are frequently misinterpreted as achalasia, and the endoscopic picture is often difficult to interpret. This report describes the case histories of three patients with giant intraluminal polyps of the esophagus. Each presents slightly different clinical features. The signs and symptoms are discussed in terms of the pathophysiology. Common pitfalls in diagnosis are reviewed. Suggestions to enable more accurate identification of these lesions are given. Finally, a systemic approach to treatment is outlined which offers the patient symptomatic relief while minimizing surgical complications and morbidity.

[Benign tumors in the upper gastrointestinal tract (author's transl)]

Information is given on 113 cases of solitary or multiple benign tumors of the upper gastrointestinal tract. The clinical symptoms and procedures of diagnosis of these rare tumors of esophagus, stomach, and small intestine are discussed. For therapy, surgical intervention is usually required because of malignant degeneration and complications like bleeding or perforation. Mortality was found to be 4.4%, so that the individual indication for operation should be considered.

Primary adenocarcinoma of the esophagus arising in a columnar-lined esophagus

A patient presenting with dysphagia and weight loss was found to have a large midesophageal mass. Five biopsies indicated only adenoma but a brush cytology specimen under direct vision was diagnostic of adenocarcinoma. Esophagotomy and resection of tumor, with follow-up radiotherapy were performed; histologic examination confirmed the diagnosis. To date, there has been no recurrence of the tumor. This patient was subsequently found to have a columnar-lined esophagus. Since columnar-lined esophagus may predispose to malignancy, this case illustrates the diagnostic importance of direct-vision cytology in patients with columnar-lined esophagus.