Benign Esophageal Tumors 1-100

Question 1

what is more common, benign or malignant esophageal tumors ?

Answer 1

Malignant

Question 2

Most common benign esophageal tumors

Answer 2

1. Esophageal leiomyomas
   
   1. some may have been gastrointestinal stromal tumors (GISTs)
2. Esophageal cysts
3. Granular cell tumors (GCTs)
4. Fibrovascular polyps
5. squamous papillomas.

Question 3

Benign Tumors that involve the first and second layers of the esophagus

Answer 3

1. Granular cell tumor (submucosa per SS )
2. Fibrovascular polyp
3. Squamous cell papilloma
4. Retention cyst

Mnemonic: GFRS

Question 4

Benign Tumors from the 3rd layer of the esophagus

Answer 4

1. Lipoma
2. Hemangioma
3. Fibroma
4. Neurofibroma
5. Granular cell tumor
6. Salivary gland type tumor

Question 5

Benign tumors that arise from the 4th layer of the esophagus

Answer 5

1. Leiomyoma
2. GIST
3. Leiomyosarcma

Question 6

benign CTumors found in the EUS 5th layer

Answer 6

cyst

Question 7

Presentation of benign Esophageal tumors

Answer 7

• Slow: 50% are asymptomatic
• Dysphagia 2/2 luminal obstruction
• Most tumors are asymptomatic until 5cm

Question 8

Size at which Benign tumors become symptomatic

Answer 8

5cm

Question 9

Outter most layer of the esophagus

Answer 9

longitudinal muscle

Question 10

Conduct of barium esophogram

Answer 10

• Barium Esophogram: the standard first test for a patient presenting with dysphagia
  
  • Conduct: biphasic:
  • 1. upright double-contrast view with high-density barium allowing for the evaluation of the mucosa
  • 2. prone single-contrast view with low-density barium allowing for evaluation of luminal narrowing

Question 11

CT Scan in the evaluation of (benign) esophageal mass.

Answer 11

CT imaging is useful when:

• to for extra-esophageal tumors
• to exclude the possibility of other mediastinal tumors

CT cannot differentiate between the several layers of the esophageal wall.

Question 12

EUS factors favoring a benign lesion.

Answer 12

small size

smooth borders

homogenous echo pattern

lack of surrounding enlarged lymph nodes.

Question 13

size criteria for the decision of resection of mucosal tumor

Answer 13

< 2cm endoscopic

above… surgical

Question 14

Lamier triangle.

Answer 14

1. typically located in the posterior midline above the confluence of the longitudinal layer of muscle known as the Lamier triangle. … common location of fibrovascular polyps

Question 15

Anatomy of fibrovascular polyps

Answer 15

1. Anatomy:
   
   1. upper third of the esophagus
   2. typically located in the posterior midline above the confluence of the longitudinal layer of muscle known as the Lamier triangle.

Question 16

Pathophysiology of fibrovascular polyps

Answer 16

1. Pathophysiology:
   * tumors are caused by submucosal thickening and are often based on a long pedicle secondary to the effects of peristalsis

Question 17

Histological make up of fibrovascular polyps

Answer 17

• variable makeup -
• including fibrous, vascular, adipose, and neural tissues.

Question 18

Typical presentation of fibrovascular polyps

Answer 18

1. Presentation

• Most patients complain of dysphagia and respiratory symptoms
• Large fibrovascular polyps can present with dysphagia and/or obstruction and rarely with regurgitation into the hypopharynx with aspiration and asphyxiation,

Question 19

Treatment of a fibrovascular polyps

Answer 19

• Resection is recommended secondary to the risk of airway compromise.
  
  1. EUS is beneficial in determining the vascularity of the stalk, the location, and the size: all of which are helpful in planning resection.
  2. Smaller lesions can be removed endoscopically with direct snare or EMR techniques.
  3. Larger lesions or lesions with a highly vascular stalk should be resected via a longitudinal esophagotomy on the side opposite the tumor stalk followed by ligation and resection of the tumor and two-layer closure of the esophagotomy

Question 20

The appearance of hemangioma on EUS.

Answer 20

1. Appearance on EUS:
   
   1. These tumors appear as dark purplish-red nodules
   2. can present as a solitary lesion or as multiple lesions in cases of the Rendu–Osler–Weber syndrome.
   3. EGD is helpful in diagnosing these tumors given their characteristic appearance and EUS will show a hypoechoic, submucosal mass arising from the second or third layer with sharp margins.

Question 21

Clinical presentation of a hemangioma?

Answer 21

1. Clinical Presentation:
   
   1. Most are asymptomatic.
   2. Symptomatic lesions may present with dysphagia and retrosternal pain
   3. Rare: hematemesis, which may be secondary to mucosal ulceration.

Question 22

what is the treatment of Hemangioma?

Answer 22

1. Treatment:
   
   1. Asymptomatic tumors are followed clinically.

symptomatic lesions can be treated with endoscopic resection, sclerotherapy, radiation laser fulguration, or minimally invasive surgical resection