Intramural Benign Esophageal Tumors

Published on 20/07/2015 by admin

Filed under Radiology

Last modified 20/07/2015

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 Discrete mass; solitary (most common) or multiple

image Round or ovoid filling defects sharply outlined by barium on each side (en face view)
image Narrowed (tangential view) or stretched and widened (en face view) esophageal lumen
image Smooth surface lesion, with upper and lower borders of lesion forming right or slightly obtuse angles with adjacent esophageal wall (profile view)
image Overlying mucosa may ulcerate
• Leiomyoma: ± amorphous or punctate calcifications
• Esophageal gastrointestinal stromal tumor (GIST)

image May be large mass
image May ulcerate with gas ± contrast medium entering cavity
• CT: Discrete mass in wall; no signs of invasion or metastases

image Helps distinguish lipoma (fat density) and other mediastinal masses (e.g., mediastinal cyst)

TOP DIFFERENTIAL DIAGNOSES

• Mediastinal tumor
• Normal mediastinal structures
• Esophageal carcinoma
• Foreign body

CLINICAL ISSUES

• Asymptomatic: No treatment
• Large, symptomatic lesions: Enucleation or esophageal resection with gastric interposition

DIAGNOSTIC CHECKLIST

• Most intramural masses are benign (unlike gastric tumors)
• Leiomyomas are much more common than GIST in esophagus (but not in stomach)
• Calcifications suggest leiomyoma; almost never occur in other benign/malignant esophageal tumors
image
(Left) Film from a barium esophagram demonstrates a mass image causing eccentric narrowing of the distal lumen. The mass forms obtuse angles with the wall, and the esophageal folds and mucosa are intact. A leiomyoma was enucleated endoscopically.

image
(Right) Single-contrast esophagram shows an en face view of an intramural mass in the distal esophagus with central ulceration image due to leiomyoma. The traction diverticulum image is an incidental finding.
image
(Left) Coronal CECT in a 24-year-old man shows a huge, soft tissue density mass that envelops and displaces the distal esophagus image. Small foci of calcification image are noted. The mass was resected and proved to be a benign leiomyoma arising from the esophageal wall.

image
(Right) Axial CECT in a 73-year-old woman shows a huge esophageal mass image with a large central ulceration image that contains gas due to communication with the esophageal lumen. The central cavitation is typical of a GIST; the esophagus is an unusual site.

TERMINOLOGY

Definitions

• Benign mass composed of 1 or more tissue elements of esophageal wall

IMAGING

General Features

• Best diagnostic clue

image Intramural mass with smooth surface and slightly obtuse borders on barium esophagram
• Size

image 1 cm to > 10 cm
• Other

image Types include leiomyoma, GI stromal tumor, granular cell, lipoma, hemangioma, hamartoma

Radiographic Findings

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