[Leiomyomas and extramucosal cysts of the esophagus in adults. The clinical picture and surgical therapy].

BACKGROUND: Leiomyoma is the most common type of benign esophageal tumor, whereas extramucosal cysts of the esophagus are congenital anomalies frequently asymptomatic in the adult and in most cases detected incidentally on chest X-ray. Conventional imaging tests do not lead to a precise diagnosis. Endoscopic ultrasonography is very accurate in visualizing these lesions and in differentiating cystic from solid submucosal esophageal masses; in addition, the test can establish the exact location of the mass in relation to the esophageal wall and mediastinum.
METHODS: Fifteen patients with esophageal leiomyoma and 27 patients with extramucosal esophageal cyst were operated on in our Institution. Dysphagia was the most common symptom in patients affected by leiomyoma and esophageal duplication cyst, whereas chest pain was more frequent in patients with bronchogenic cyst.
RESULTS: Complete surgical excision of the mass was performed in all patients with esophageal leiomyoma and in 26 patients with mediastinal cyst, while a right upper pulmonary lobectomy was performed in the patient with an intrapulmonary cyst.
CONCLUSIONS: Endoscopic ultrasonography plays an important role in the differential diagnosis of leiomyoma and mediastinal cyst. Surgery is mandatory in all patients especially after the advent of the mini-invasive procedures. Observation alone must be reserved for patients who refuse or are not suitable for thoracic surgery.