Intramural Benign Esophageal Tumors

Michael P. Federle, MD, FACR

Key Facts

Imaging

Types include leiomyoma, GI stromal tumor, granular cell, lipoma, hemangioma, hamartoma
Fluoroscopic-guided barium studies
- Discrete mass; solitary (most common) or multiple
- Round or ovoid filling defects sharply outlined by barium on each side (en face view)
- Narrowed (tangential view) or stretched and widened (en face view) esophageal lumen
- Smooth surface lesion, with upper and lower borders of lesion forming right or slightly obtuse angles with adjacent esophageal wall (profile view)
- Overlying mucosa may ulcerate
Leiomyoma: ± amorphous or punctate calcifications
Esophageal GIST
- May be large mass
- May ulcerate with gas ± contrast medium entering cavity
CT: Discrete mass in wall; no signs of invasion or metastases
- 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)

(Left) Film from a barium esophagram demonstrate a mass

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. (Right) Single contrast esophagram shows an en face view of an intramural mass in the distal esophagus with central ulceration