| Theme | Gastrointesinal Submucosal Tumor -- Advances in the Diagnosis and Treatment | |
|---|---|---|
| Title | Diagnosis of Esophageal Submucosal Tumors | |
| Publish Date | 2001/03 | |
| Author | Tsuneo Oyama | Department of Gastroenterology, Saku Central Hospital |
| Author | Yoshinori Miyata | Department of Gastroenterology, Saku Central Hospital |
| Author | Akihisa Tomori | Department of Gastroenterology, Saku Central Hospital |
| Author | Kin-ichi Hotta | Department of Gastroenterology, Saku Central Hospital |
| Author | Shigeki Shimaya | Department of Gastroenterology, Saku Central Hospital |
| Author | Akihiko Togou | Department of Surgery, Saku Central Hospital |
| [ Summary ] | Esophagography, esophagoscopy and miniature probes are useful for the diagnosis of a small esophageal submucosal tumors (SMT). CT and MRI are useful for the diagnosis of a large esophageal SMT. Esophagography and esophagoscopy reveal hard, smooth submucosal tumors. Endoscopic ultrasonography (EUS) reveals hypo-echoic mass lesions. Leiomyomas derived from the muscularis mucosae or the submucosal layer grow toward the esophageal lumen. And they derived from the proper muscular layer reveal intra-luminal or extramural growth. The characteristic macroscopic findings for leiomyosarcoma are a large SMT, 5cm or over in size, which is irregular in shape. Differential diagnosis between leiomyoma and leiomyosarcoma is sometimes difficult, because biopsies are difficult to do. EUS reveals a mosaic pattern and invasive growth. A gastro-intestinal stromal tumor (GIST) is rare in the esophagus. The characteristic macroscopic findings of GIST and differential diagnosis between GIST and leiomyoma are unknown. Lipoma and lymphangioma display soft SMT. EUS is very useful for the differential diagnosis between them, because lipoma displays hyper-echoic masses, and lymphangioma reveals hypo-echoic mass lesions. The granular cell tumors reveal a characteristic tooth like yellowish SMT. EUS reveals hypo-echoic solid mass lesions in the second low-echo or third hyper-echoic layer. The most important thing for differential diagnosis of a esophageal SMT is knowing the macroscopically and ultrasonographically characteristic features of SMT. |
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