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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

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CASE REPORT
Year : 1991  |  Volume : 37  |  Issue : 4  |  Page : 235-7,236A

Hamartoma--a benign intraluminal tumor of the oesophagus (a case report).


Department of Radiodiagnosis, Kasturba Medical College and Hospital, Manipal, South Kanara, Karnataka.

Correspondence Address:
Department of Radiodiagnosis, Kasturba Medical College and Hospital, Manipal, South Kanara, Karnataka.


  ::  Abstract

Benign tumours of the oesophagus are rare, representing less than 1% of all oesophageal neoplasms. Most of them are intramural leiomyomas while the other benign tumours are encountered only infrequently; among these pedunculated intraluminal hamartomas form a particularly rare group. We present here one such case.

How to cite this article:
Lakhkar B N, Ghosh M K, Shenoy P D, Patil U D. Hamartoma--a benign intraluminal tumor of the oesophagus (a case report). J Postgrad Med 1991;37:235-7,236A


How to cite this URL:
Lakhkar B N, Ghosh M K, Shenoy P D, Patil U D. Hamartoma--a benign intraluminal tumor of the oesophagus (a case report). J Postgrad Med [serial online] 1991 [cited 2021 Sep 27];37:235-7,236A. Available from: https://www.jpgmonline.com/text.asp?1991/37/4/235/745




  ::   Introduction Top

In 504 oesophageal tumours collected from 19,982 autopsies during a 50-year-period Plachta[7] found that 82% were carcinomas and 18% were benign tumours. These have been classified into two large groups, sessile, which remain mostly intramural and pedunculated, which are intraluminal. The sessile tumours are, by far the most prevalent and are usually leiomyomas. Among the pedunculated tumours the fibrovascular polyp is the most common; however other histological varieties can also be encountered such as lipomas, fibromas and myxomas. More rare are hemangiomas, lymphangiomas and hamartomas. The following is the case report of an uncommon benign oesophageal tumour.

  ::   Case report Top

A 30-year-old female presented with progressive dysphagia and gradual restriction of oral intake since last 5 years. During all this time she had been having episodes of regurgitation of a fleshy mass between her teeth, associated with severe respiratory distress relieved when the patient manually reduced the mass into her oesophagus. She had lost about 10 kg weight, but maintained good health. Her physical examination was unremarkable. Barium swallow study demonstrated multiple polypoid filling defects in the oesophagus (See [Figure:1A] and [Figure:1B]). Video recording during swallowing demonstrated the mass to move up and down in the oesophagus. At rest it assumed a position in the midoesophagus. A presumptive diagnosis of oesophageal polyp was made.
Surgical resection was carried out through a transverse lower cervical incision. A multilobulated tumour mass was visualised. The stalk of the mass was identified to be below the level of cricopharyngeus muscle, with gentle upward traction, the entire polyp could be easily brought out through the esophagotomy. The vessels in the pedicle were separated from the rest of the base and individually ligated and divided. The entire polyp was then removed by excising the remainder of the stalk between sutures. The neck incision was closed with a small drain left for drainage. Post-operatively the patient had a uneventul recovery and was completely relieved of all her symptoms. Grossly the polyp was fleshy in consistency and had smooth and shiny surface with no ulcerations (See Fig. 2). Microcopically the tumour was lined by squamous epithelium and there were large hyperplastic and cystic glands with abundant well vascularized stroma infiltrated by inflammatory cells (See [Figure - 3]).

  ::   Discussion Top

Benign tumours of the oesophagus are distinctly uncommon. Schaffer et al[9] recorded 11 cases out of a total of 6001 autopsies; while Moersch et al[8] encountered 44 out of 7,459 autopsies. Esophageal polyps are the most common intraluminal tumours although its occurrence is rare. Depending on their histological features they can be termed as fibromas, fibroliponias, fibrovascular polyps or Iipomas. In presence of mixed architecture they are called hamartomas[1].
Pedunculated oesophageal hamartomas are not true neoplasms, but represent developmental lesions of obscured origin. Possibly they are derived from nests of embryonic tissue associated with the development of the foregut and the trachcobronchial groove[10]. It has been suggested that a cornbination of remarkable looseness of the submucous tissue in the upper oesophagus together with active peristaltic movements with molding result in the development of these long pedunculated polyps[2].
It appears that these hamartomatous polyps produce few symptoms until they reach an impressive size. Dysphagia is the most common symptom, which was found in our patient. Some other complaints include a sense of "lump in the throax, partial regurgitation of a fleshy mass in the mouth and its disappearance upon swallowing. Asphyxia due to laryngeal impaction of a regurgitated polyp has been well described in the literature[4]. Weight loss if present is related to dysphagia and not to the size and the growth of the polyp. Our patient who was a 30-year-old female presented with episodes of regurgitation of a fleshy mass in the throat associated with respiratory distress. Hematemesis or occult gastrointestinal bleeding may occur and is probably related to ulceration of the tumour.
On barium swallow the polyps appear as a smooth intra-luminal filling defects. The Cine-oesophagogram would disclose these filling defects to be mobile with swallowing and oesophageal contractions[6]. They are commonly seen in upper third of the oesophagus, and assume large proportions. Polypoid masses upto 25 cm have been described. 5 In our case barium swallow study was done in the erect position. The barium bolus was seen descending to the level of the tumour and being momentarily delayed by the lesion. The flow of barium was seen around the tumour in the oesophageal lumen. In oblique projections the tumour appeared to be surrounded by a thin layer of barium. Hence, the point of attachment to the oesophageal wall could not be precisely determined. The oesophagus appeared wide at the site of tumour; but there was no evidence of any complete obstruction. Video recording demonstrated the movement of the filling defect with swallowing and oesophageal contractions. Thus confirming the diagnosis of oesophageal polyp.
Complete relief of symptoms is attained with excision of the tumour. The treatment of choice is complete surgical excision because of the possibility, although very rare, of malignant degeneration. The possibility of progressive or complete obstruction of the oesophagus or sudden obstruction of the larynx warrants prompt excision once the diagnosis is established[3].

  ::   References Top

1. Barki Y, Elias H, Tovi F, Bar-Ziv J. A fibrovascular polyp of the esophagus. Brit J Radiol 1981; 54:142-144.  Back to cited text no. 1    
2.Beeler RC, Collins JN, Hall MF. Benign pedunculated tumours of the esophagus. Amer J Roentgenol 1948; 60:466-470.  Back to cited text no. 2    
3.Bernatz. PE, Smith JE, Ellis FH Jr, Anderson HD. Benign pedunculated intraluminal turnors of the esophagus. J Thorac & Cardivasc Surg 1958; 35:503-511.  Back to cited text no. 3    
4.Cochet B, Hohl P, Sans M, Cox JN. Asphyxia caused by laryngeal impaction of an esophageal polyp. Arch Otolaryngol 1980; 106:176-178.  Back to cited text no. 4    
5.Elner A, Palm NG. Pedunculated intramural fibro-lipoma of the oesophagus. Case report. Acta Otolaryngol 1976; 82:457-462.  Back to cited text no. 5    
6.Patel J, Kieffer RW, Martin M, Avant GR. Giant fibrovascular polyp of the esophagus. Gastroenterology 1982; 87:953-956.  Back to cited text no. 6    
7.Plachta A. Benign tumours of the esophagus. Review of literature and report of 99 cases. Amer J Gastroenterol 1962; 38:639-652.  Back to cited text no. 7    
8.Moersch HJ, Harrington SW. Benign tumour of the esophagus. Ann Otol Rhinol Laryngol 1944; 53:800-817.  Back to cited text no. 8    
9.Schafer PW, Kittle CF. Esophageal leiomyoma. Report of a successful resection. J Amer Med Assoc 1947; 133:1202-1205.  Back to cited text no. 9    
10.Venn GE, DaCosta P, Goldstraw P. Giant oesophageal hamartoma. Thorax 1985; 40:684-685.   Back to cited text no. 10    

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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