Benign Esophageal Tumors

ResumenEl estudio de las enfermedades esofágicas requiere de múltiples exámenes diagnósticos, ya que ninguno, por sí solo, provee total información sobre la funcionalidad y la anatomía del tracto digestivo superior. Para los cirujanos generales y gastrointestinales, el esofagograma constituye una herramienta esencial que, además de sugerir un diagnóstico, ofrece una idea de la anatomía del órgano y nos permite esbozar un mapa de fácil evaluación (sin la necesidad de un radiólogo), para establecer o definir un plan quirúrgico. El objetivo del presente artículo es mostrar al lector la utilidad del esofagograma en centros de referencia en el estudio y el tratamiento de las enfermedades esofágicas, así como su representación en algunas enfermedades frecuentes. Palabras clavesEsófago, enfermedades del esófago, neoplasias esofágicas, esofagograma. AbstractThe study of esophageal diseases requires multiple diagnostic tests since no one test alone can provide full information on upper digestive tract anatomy and functionality. For general surgeons and gastrointestinal surgeons, the esophagogram is an essential tool that can suggest a diagnosis while simultaneously providing an idea of the anatomy of the organ and outlining an easily evaluated map without the need of a radiologist. This information can be used to establish a surgical plan. The aim of this article is to show readers the usefulness of esophagograms at referral centers for study and treatment of esophageal diseases while providing representations of several frequent diseases. KeywordsEsophagus, diseases of the esophagus, esophageal neoplasms, esophagogram.Revisión de tema DOI: https://doi.org/10.22516/25007440.157 INTRODUCCIÓNEl estudio de las enfermedades del esófago requiere de múltiples ayudas diagnósticas que aporten, dependiendo de la enfermedad, información sobre su funcionalidad o anatomía. El esofagograma es un estudio radiológico diná-mico del tracto digestivo superior que utiliza un medio de contraste y aire (doble contraste) y permite realizar una aproximación diagnóstica de anomalías estructurales y funcionales del esófago. Para los cirujanos generales y gastrointestinales, este estudio -cada vez más en desuso-es un instrumento esencial que nos acerca al diagnóstico y planeación de un tratamiento quirúrgico.El objetivo del presente artículo es mostrar la utilidad del esofagograma en centros de referencia en el estudio y el tratamiento de las enfermedades esofágicas, así como su

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“…La resección endoscópica o quirúrgica representa una opción terapéutica en pacientes con síntomas (26,27) (Figura 9).…”

Section: (Figura 9)unclassified

“…Estos tumores se presentan con disfagia y dolor torácico, y son masas generalmente móviles no obstructivas que rara vez causan dilatación esofágica. La cirugía está reservada para los pacientes sintomáticos (27) (Figura 9).…”

Section: (Figura 9)unclassified

Esofagograma: imágenes que valen mas que mil palabras

Segura

Gómez

Meza

et al. 2017

Rev. Colomb. Gastroenterol.

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“…It was reported that about 30% to 33% of esophageal leiomyomas were found in the middle thoracic esophagus (4,5). Digital gastrointestinal imaging, thoracic CT and EUS are need to be performed to identify the tumor type.…”

Section: Commentsmentioning

confidence: 99%

“…Digital gastrointestinal imaging, thoracic CT and EUS are need to be performed to identify the tumor type. Minimally invasive techniques have become leading approaches to remove esophageal leiomyoma for decreasing postoperative complications, improving postoperative pain control and shorting hospital stays (4). For leiomyoma in the middle thirds of the esophagus, cutting azygos vein in minimally invasive surgeries has been recommended in many articles, because it can benefit surgical exposure and facilitate operations in resecting leiomyoma (1,5).…”

Section: Commentsmentioning

confidence: 99%

A useful method to keep azygos arch in minimally invasive resection of esophageal leiomyoma

Chen

Han

et al. 2017

J. Thorac. Dis.

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Lifting azygos arch with a prolene line is a useful way to keep azygos arch in minimally invasive resection of esophageal leiomyoma without affecting surgical exposure and operative procedure. J Thorac Dis 2017;9(11):4589-4591 jtd.amegroups.com arch. After the azygos vein was fully freed, 4-0 prolene line was threaded through the azygos vein. ENDO CLOSE needle (product number: T173022, COVIDIEN company) was inserted in the posterior axillary line at the fourth intercostal space to catch the prolene line and bring the prolene line out of the chest. After that, the end of prolene line was pulled to vertically sling the azygos vein and fixed on a sterile surgical towel (Figure 2). Thus, the surgical field below the azygos vein could be fully exposed. The surgeon used the ultrasonic knife to open the esophageal fibrous membrane, muscular. The tumor was separated from esophageal mucosa with blunt dissection using "pea nut" which was made with sterile gauze. After checking bleeding and the integrity of esophageal mucosa, the esophageal muscular layer and the mediastinal pleura were closed with interrupted sutures to prevent postoperative diverticular formation. We provided a surgery video containing detailed procedure for you to refer to ( Figure 3).After surgery, digital gastrointestinal imaging showed no esophageal thoracic cavity fistula. The final pathologic examination demonstrated that the mass was leiomyoma. The results of immunohistochemical stains showed positive stains for smooth muscle actin and Desmin and negative stains for CD117, CD34 and DOG-1. Besides, Ki-67 was 1% positive stains. The stomach tube was extubated on the third day, and the patient started a liquid diet. The patients could have normal diets with no symptom of dysphagia and regurgitation three months later. CommentsIt was reported that about 30% to 33% of esophageal leiomyomas were found in the middle thoracic esophagus (4,5). Digital gastrointestinal imaging, thoracic CT and EUS are need to be performed to identify the tumor type. Minimally invasive techniques have become leading approaches to remove esophageal leiomyoma for decreasing postoperative complications, improving postoperative pain control and shorting hospital stays (4). For leiomyoma in the middle thirds of the esophagus, cutting azygos vein in minimally invasive surgeries has been recommended in many articles, because it can benefit surgical exposure and facilitate operations in resecting leiomyoma (1,5). However, cutting azygos vein alters venous circulation. And the instrument is needed during operation to push the azygos vein arch stub away for a better surgical exposure. We indicate a useful surgical technique, vertical sling of the azygos vein, which can fully expose surgical field without

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“…1 Esophageal leiomyomas are rare benign intramural tumors with an incidence of 0.006-0.1%. They account for two-thirds of all benign esophageal tumors 7 and may be found at any age, but mostly between 30 and 50 years of age. 7 The tumors often remain stable in size for years and malignant transformation to leiomyosarcoma has been reported in only four cases.…”

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confidence: 99%

Recurrent fusion of the genes FN1 and ALK in gastrointestinal leiomyomas

et al. 2016

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Leiomyomas of the gastrointestinal tract are mostly found in the esophagus, stomach, and colon. Genetic information about them is very limited and no fusion genes have been described. We present herein cytogenetic and molecular genetic analyses of two gastrointestinal leiomyomas found in the esophagus and small intestine. The esophageal leiomyoma had the karyotype 45,Y,der(X)t(X;6)(p22;p21),inv(2)(p23q35),add(6)(p21),-11[cp6]/46,XY[7]. The intestinal leiomyoma karyotype was 46,X,add(X)(q2?),der(2)add(2)(p23)add(2)(q33),add(4)(p14),add(14)(q22)[10]/47,XX,+12[2]/46,XX[1]. RNA-sequencing detected FN1-ALK fusion transcripts in both tumors. RT-PCR together with Sanger sequencing verified the presence of the FN1-ALK fusion transcripts. Fluorescence in situ hybridization using an ALK breakapart probe further confirmed the rearrangement of the ALK gene. Immunohistochemical investigation of ALK in the leiomyoma of the small intestine revealed positivity with strong granular cytoplasmatic staining in the tumor cells. This is the first ever ALK fusion reported in gastrointestinal leiomyomas. Our results are of potential clinical importance because crizotinib, a selective ALK inhibitor, has demonstrated effect in patients whose tumors harbor ALK rearrangements. Thus, ALK emerges as a possible therapeutic target in patients whose tumors, including gastrointestinal leiomyomas, carry ALK fusions.

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Benign Esophageal Tumors

Cited by 38 publications

References 65 publications

Esofagograma: imágenes que valen mas que mil palabras

Esofagograma: imágenes que valen mas que mil palabras

A useful method to keep azygos arch in minimally invasive resection of esophageal leiomyoma

Recurrent fusion of the genes FN1 and ALK in gastrointestinal leiomyomas

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