Benign esophageal tumors are rare, accounting for only 1% of all esophageal tumors. The age of onset is younger than that of esophageal cancer, with slow symptom progression and a long disease course. The most common benign esophageal tumor is leiomyoma, accounting for about 90% of cases. Other types include polyps originating from the mucosal and submucosal layers, lipomas, fibrolipomas, and papillomas. Esophageal leiomyomas are more common in middle-aged men. They are typically located in the lower and middle segments of the esophagus and are mostly solitary. Leiomyomas originate from the muscular layer of the esophageal wall and grow slowly both inward and outward, while the mucosa remains intact, thus not causing hematemesis. The tumors are round, oval, or horseshoe-shaped, with a complete capsule and a tough texture. The cut surface appears gray-white with a whorled structure, measuring 2–5 cm in diameter, though they can sometimes grow up to 10 cm or larger, encircling a long segment of the esophagus.

bubble_chart Clinical Manifestations

Clinically asymptomatic esophageal leiomyomas with small tumor size can be followed up regularly without the need for immediate surgical intervention. For larger tumors that present clinical symptoms or cause significant anxiety in patients despite being asymptomatic, esophageal leiomyoma excision is recommended. The surgical approach involves entering the chest through a right or left thoracotomy incision. After opening the mediastinal pleura and exposing the esophagus, the muscular layer is incised longitudinally to enucleate the leiomyoma outside the mucous membrane. The muscular layer incision is then loosely sutured. If the mucous membrane is damaged during the procedure, interrupted inverting sutures should be applied, followed by suturing the muscular layer and covering it with the mediastinal pleura. For giant leiomyomas that encircle the esophagus, partial esophageal resection with esophagogastric anastomosis is required.

Esophagoscopy: A submucosal mass protruding into the esophageal lumen can be observed, but the mucosa appears normal. For cases of smooth muscle tumors, biopsy is contraindicated during esophagoscopy to avoid injuring the esophageal mucosa, which could complicate subsequent tumor resection.

bubble_chart Treatment Measures

Esophageal leiomyomas may remain asymptomatic for a long time and are often incidentally discovered during a barium meal X-ray examination of the digestive tract. When the leiomyoma grows larger, typically exceeding 5 cm, it may present with symptoms such as retrosternal fullness, pain, pressure, and a grade I sensation of swallowing obstruction. Barium esophagography can reveal a smooth, well-defined round or oval filling defect, with sharp angles at the upper and lower borders where it meets the normal esophageal wall. The esophageal mucosal folds in the tumor area are flattened and disappear due to the tumor's expansion but are not disrupted. During swallowing, the leiomyoma may be observed moving up and down with the esophagus.