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World J Gastroenterol. Jan 28, 2015; 21(4): 1091-1098
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1091
Benign esophageal lesions: Endoscopic and pathologic features
Shu-Jung Tsai, Ching-Chung Lin, Chen-Wang Chang, Chien-Yuan Hung, Tze-Yu Shieh, Horng-Yuan Wang, Shou-Chuan Shih, Ming-Jen Chen
Shu-Jung Tsai, Ching-Chung Lin, Chen-Wang Chang, Chien-Yuan Hung, Tze-Yu Shieh, Horng-Yuan Wang, Shou-Chuan Shih, Ming-Jen Chen, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10001, Taiwan
Shu-Jung Tsai, Ching-Chung Lin, Chen-Wang Chang, Chien-Yuan Hung, Tze-Yu Shieh, Horng-Yuan Wang, Ming-Jen Chen, Department of Nursing, Nursing and Management, Mackay Junior College of Medicine, Taipei 10001, Taiwan
Shu-Jung Tsai, Ching-Chung Lin, Chen-Wang Chang, Chien-Yuan Hung, Tze-Yu Shieh, Horng-Yuan Wang, Shou-Chuan Shih, Ming-Jen Chen, Mackay Medical College, New Taipei 25243, Taiwan
Author contributions: Chen MJ conducted the review design; Tsai SJ and Lin CC wrote the article; Lin CC and Chen MJ prepared the endoscopic photographs; Hung CY and Shieh TY conducted the literature review; Shih SC supported this work and critically read the manuscript; Wang HY and Chen MJ supported this work and supervised the final editing; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ming-Jen Chen, MD, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Chungshan North Road, Taipei 10001, Taiwan. mingjen.ch@msa.hinet.net
Telephone: +886-2-25433535-2260 Fax: +886-2-25433642
Received: July 23, 2014
Peer-review started: July 24, 2014
First decision: September 15, 2014
Revised: September 23, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: January 28, 2015
Abstract

Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the lesion causes symptoms. We suggest endoscopic resection of all granular cell tumors and squamous papillomas because, while rare, these lesions have malignant potential. Dysphagia aortica should be considered in the differential diagnosis of dysphagia in the elderly.

Keywords: Benign tumor, Esophagus, Epithelial lesions, Subepithelial lesions, Endoscopy

Core tip: Benign esophageal tumors have a lower detection rate due to the fact that most patients are asymptomatic. The majority of these benign lesions are asymptomatic, and diagnoses are often made incidentally during investigations for other symptoms. Although biopsy or excision is required for a definitive diagnosis, understanding the endoscopic appearances provides essential help for differential diagnosis. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor.