Endoscopic signs of esophageal tumors

Benign tumors of the esophagus

Benign tumors of the esophagus are divided into:

Exophytic tumors. Grow mainly in the lumen of the esophagus:

• polyp,
• papilloma,
• lipoma,
• leiomyoma and others.

Endophytic tumors (intramural). Diagnosed hard, mainly by changing the color and texture of the mucosa, the local change in the lumen and a slight pretenotomy. Mucous over an endophytic tumor can be eroded, swollen, and maybe unchanged. A positive symptom of the tent. With instrumental palpation of tight-elastic consistency.

Leiomyoma. Is up to 70%. It is a submucosal non-epithelial tumor, consisting of chaotically located bundles of smooth musculature of the esophagus. In 50% is located in the lower third of the esophagus.

There are 3 forms of the tumor:

• in the form of an isolated node,
• in the form of multiple nodes,
• common oesophageal leiomyomatosis.

Leiomyoma looks like a regular rounded or oval shaped formation, protruding into the lumen of the esophagus, rather dense, with mucous not soldered (for large sizes and ulceration it can be soldered - then the tent is negative). Like all submucosal tumors of the esophagus, the size and shape of the leiomyoma do not change with respiration. The course is long-term asymptomatic, manifested with bleeding or dysphagia.

Tactics: up to 2 cm is usually removed through an endoscope, but if there is bleeding in an anamnesis - it is better to have surgery. At large sizes, they are observed in dynamics 1 time in 6 months. With rapid growth and bleeding - surgery.

Papilloma. Externally is a whitish elevation against the background of a pink mucous membrane, growing on a pedicle or on a broad base. Size from the pinhead to 0.2-0.5 cm. Papillomas can be single or multiple. They have a high index of malignancy. Subject to endoscopic removal with histological examination.

Polyps. They are rare. Are located everywhere. The shape is round or ovoid, the surface is smooth, the outlines are even, the color does not differ from surrounding tissues, but it can be slightly brighter. It is located on a pedestal or a wide base. Often ulcerated. Dimensions are usually 0.3-1.5 cm. Tactics: endoscopic polypectomy with polyps up to 2 cm on a wide base and up to 4 cm on the stem.

Lipoma. Large lobular tumors, soldered with mucous, yellowish coloration. 

Esophageal carcinoma 

This is a widespread disease - from 10 to 90% of all diseases of the esophagus according to different data.

Localization:

• in the upper third - 15-20%,
• in the middle third - 37-47%,
• in the lower third - 38-43%.

Histological structure:

• 90% - squamous cell carcinoma,
• 10% - adenocarcinoma from the own, mucous and cardiac glands.

There is no universally recognized macroscopic classification of esophageal cancer. The most common forms are:

1. Exophytic (nodal).
2. Endophytic (diffuse-infiltrative, sclerosing).
3. Mixed (ulcerative).

With exophytic cancer, the tumor grows into the lumen of the esophagus, reminiscent of the external mulberry or cauliflower. It reaches various sizes. It breaks up early and bleeds.

In endophytic cancer, the tumor spreads through the submucosal layer along the entire circumference of the esophagus, causing it to narrow down to complete obstruction. In connection with the slow growth of the tumor, suprastenotic expansion is often formed.

Ulcerous cancer combines the signs of limited and infiltrative growth. Quickly ulcerated. The ulcer has dense, elevated, cylindrical, hummocky edges, easily bleeds.

[1], [2], [3], [4]