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home - Oesophagus - Benign Oesophageal Lesions - Benign Raised Lesions Written by Dr Sebastian Zeki

Benign Raised Lesions

HaemangiomasThe prevalence is 0.04 %.Histology shows cavernous vascular spaces.Endoscopy shows a nodular, soft, bluish red, and typically blanch when pressed with biopsy forceps.The Treatment is endoscopic resection safe Raised Oesophageal Lesions LymphangiomasThese are due to a malformation of seques-tered lymphatic tissue.These lesions are very rare (only 15 described).Endoscopic features include a translucent, yellowish, submucosal, easily compressible mass.It is usually < 5 mm.It is a submucosal lesion.Treatment is usually not needed but can be resected if causing problems. Fibrovascular polypsThese are comprised of fibromas, fibrolipomas, myomas, and lipomas.Histology involves fibrous, vascular, and adipose tissue covered by squamous epithelium.Lesions are usually in upper third of the oesophagus attached to the inferior aspect of cricopharyngeus.These are more common in males at 3:1.The average age of onset is in the 50’s.They arise from nodular thickening of a redundant mucosal fold.The polyps are usually asymptomatic.If the patients is symptomatic the polyps usually have a stalk .Do an EUS- if there is a feeding vessel, need surgery or snare with endoloop.If there is no feeding vessel, snare polypectomy is appropriate. Granular cell tumorsGranular cell tumors occur in the skin, tongue, breast, and gastrointestinal tract.10% of the lesions occur in the GI tract, 65% of these in the oesophagus.The average age of detection is 45 years.They are more common in males than females.These are usually asymptomatic but dysphagia can occur in 30%.Endoscopic features include sessile, yellowish white, and are covered by normal-appearing mucosa. 90% are solitary.The lesions are histologically composed of large polygonal cells containing numerous eosinophilic granules.They resemble Schwann cells under electron micros-copy and stain positive for S100 protein, suggesting a neural origin.The lesions have malignant potential especially if >4cm so these should be resected.They can be surveyed every 1-2 years. Only occur in Barretts- see Barrett’s section Inflammatory fibroid polypsThis is composed of reparative tissue.The lesions can be due to reflux.Lesions include hamartomas, inflammatory pse-dopolyps, and eosinophilic granulomas.Lesions are mainly found in distal oesophagus.Histological features include ia connective tissue stroma and a diffuse eosinophilic infiltrate.Treatment involves resection only if troublesome. PapillomasThe incidence is 0.02%Histology involves epithelium lined by an increased number of squamous cells.There is a core of connective tissue with small blood vessels.The lesion is possibly associated with GERD or NG tube insertion.Endoscopy usually shows a solitary small, whitish pink, wart-like exophytic projectionClinical manifestationsAge: 50s; M=FTreatment involves EMR if >1cm or<1cm cold biopsy/snare. Recurrence after resection is infrequent. Gastrointestinal stromal tumors, leoimyomas, and leoimyosarcomasSee GIST section Treatment: Adenomas Treatment: Papilloma associations:Tylosis.Acanthosis nigricans.Goltz syndrome (congenital focal dermal hypoplasia that features hyperpigmentation, sclerodactyly, dysplastic changes of the teeth and bones, and perianal, oroesophageal, and genital papillomas. Histology: Dilated endothelial spaces with cavities lined by flat endothelial cells containing eosinophilic material. Written by Dr Sebastian Zeki

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