Journal List > Korean J Gastroenterol > v.61(2) > 1007115

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Cho, Moon, Kim, Kim, Joo, Kim, Park, Choi, Kim, and Cho: Clinicopathologic Feature of Esophageal Submucosal Tumors Treated by Surgical Approach
Original Article

Korean J Gastroenterol 2013;61(2):71-74.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.2.71

Clinicopathologic Feature of Esophageal Submucosal Tumors Treated by Surgical Approach

Su Yeon Cho, Hyeon Jong Moon1, Ji Won Kim, Byeong Gwan Kim, Sae Kyung Joo, Young Hoon Kim, Jin Sun Park, Won Jae Choi, Su Hwan Kim, Suk Ki Cho2

Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea

1Department of Thoracic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea

2Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to: Hyeon Jong Moon, Department of Thoracic Surgery, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-849, Korea. Tel: +82-2-870-2292, Fax: +82-2-870-3866, E-mail: moon730@medigate.net

Received 15 December 201216 December 2012       Accepted 17 December 2012

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach.

Methods

We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012.

Results

The mean age was 48.9 years old and male to female ratio was 2.6：1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%).

Conclusions

Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.

Keywords: Esophagus, Submucosal, Leiomyoma, Gastrointestinal stromal tumors, Enucleation

References

1. Seremetis MG, Lyons WS, deGuzman VC, Peabody JW Jr. Leiomyomata of the esophagus. An analysis of 838 cases. Cancer. 1976; 38:2166–2177.
2. Polkowski M, Butruk E. Submucosal lesions. Gastrointest Endosc Clin N Am. 2005; 15:33–54.
crossref
3. Nishida T, Hirota S, Yanagisawa A, et al. GIST Guideline Subcommittee. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol. 2008; 13:416–430.
crossref
4. von Rahden BH, Stein HJ, Feussner H, Siewert JR. Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc. 2004; 18:924–930.
crossref
5. Levine MS. Benign tumors of the esophagus: radiologic evaluation. Semin Thorac Cardiovasc Surg. 2003; 15:9–19.
crossref
6. Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol. 2000; 24:211–222.
7. Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg. 1995; 181:257–262.
8. Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999; 23:82–87.
9. Mutrie CJ, Donahue DM, Wain JC, et al. Esophageal leiomyoma: a 40-year experience. Ann Thorac Surg. 2005; 79:1122–1125.
crossref
10. Zwischenberger JB, Alpard SK, Orringer MB. Tumors of the esophagus. Sabiston DC, editor. Textbook of surgery: the biological basis of modern surgical practice. Philadelphia: W.B. Saunders Company;1991. p. 689–700.
11. Wright CD, Gaissert HA, Puma F, et al. The oesophagus: benign and malignant tumours. Morris PJ, Malt RA, editors. Oxford textbook of surgery. Oxford: Oxford University Press;1994. p. 893–904.
12. Nickl N. Endoscopic approach to gastrointestinal stromal tumors. Gastrointest Endosc Clin N Am. 2005; 15:455–466.
crossref
13. Chak A. EUS in submucosal tumors. Gastrointest Endosc. 2002; 56(4 Suppl):S43–S48.
crossref
14. Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy. 2005; 37:635–645.
crossref
15. Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006; 130:2217–2228.
crossref
16. Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg. 1995; 181:257–262.
17. Lee LS, Singhal S, Brinster CJ, et al. Current management of esophageal leiomyoma. J Am Coll Surg. 2004; 198:136–146.
crossref

Table 1.
Baseline Characteristics
Age (yr) Gender Total
Male Female
20–29 1 0 1
30–39 1 0 1
40–49 5 2 7
50–59 3 3 6
60–69 3 0 3
Total 13 5 18
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