Esophageal lesions

Esophageal lesions

June 03, 2010Gastroenterology

Where is the lesion?
(Mucosal, submucosal  or extraluminal) How can you tell? What is the DDX for a lesion affecting the esophagus in that location?

Answers

Esophageal Mass: Leiomyoma
Approach to UGI Masses

• Location w.r.t. lumen
  Intramural/submucosal – maintains mucosal pattern, obtuse angles
• Extraluminal – mass effect, obtuse angles
• Intraluminal/mucosal – filling defect, acute angles
• Benign or malignant appearance:          
  • Benign – smooth gradual transitions
  • Malignant – irregular, abrupt transitions, overhanging margins
• Location in ugi tract

Leiomyoma

• Finding: smooth soft tissue intramural mass that may calcify, ulcerate, and commonly has an exophytic component.
• Most common tumor of esophagus (50%).
• GIST includes leiomyoma and leiomyosarcoma.
• These tumors can be seen anywhere in the GI tract. About 50-70% of GISTs occur in the stomach; 33%, in the small bowel;5-15%, in the rectocolon; and only 1-5%, in the esophagus.
• DDX: lyphoma, sarcoma, carcinoma, mets.
• Usually assymptomatic, but can ulcerate, bleed, or undergo malignant transformation.

Esophageal filling Defects
Tumors
Benign:
              Submucosal – leiomyoma, fibroma, lipoma

               Mucosal – Papilloma, polyp(adenomatous,postinflammatory,giant fibrovascular)

Malignant:

               submucosal – Lymphoma, mets, leiomyosarcoma, GIST

               Mucosal – Carcinoma-> adenocarcinoma, SCC, verrucoid Varices – uphill, ownhill

Extrinsic lesions – tumors, congential cysts(bronchogentic, duplication), osteophytes, enlarged nodes, abberent or enlarged vessels

Foreign bodies

Distinguishing Features of Esophageal carcinoma
Risk factors – reflux, alcohol, caustics, achalasia, head and neck cancers.
90% SSC, 10% adenocarcinoma(associated with Barret’s)