Benign tumors of the esophagus are rare constituting less than 1% of esophageal neoplasms. Which of the following statement(s) is/are true concerning benign esophageal neoplasms?

c. An asymptomatic leiomyoma can be safely observed and followed with periodic barium esophograms and endoscopic ultrasonography

Leiomyomas represent the most common benign intramural esophageal tumor and characteristically occur in patients between 20 and 50 years of age. More than 80% of esophageal leiomyomas occur in the middle and lower thirds of the esophagus. Tumors less than 5 cm in size rarely cause symptoms. When larger than this, dysphagia, retrosternal pressure and pain are the common complaints. Bleeding more often occurs with the malignant form of the tumor, leiomyosarcoma. Malignant degeneration of leiomyomas is exceedingly rare. An asymptomatic leiomyoma or one discovered incidentally on a barium swallow examination can be safely observed and followed with periodic barium esophograms and endoscopic ultrasonography. Although excision of the esophageal mass provides the only definitive tissue diagnosis, the characteristic radiographic appearance, slow growth rate, and low risk of malignant degeneration and the ability to follow leiomyomas with endoscopic ultrasonography justify conservative management. Tumors that are symptomatic or larger than 5 cm in diameter should be excised. Tumors of the middle third of the esophagus are approached through a right thoracotomy, while those in the distal third are approached through a left thoracotomy. Once the esophagus is encircled and the tumor located, the overlying longitudinal muscle is split in the direction of its fibers. The tumor is then gently dissected away from the contiguous underlying submucosa and adjacent muscle. When enucleation of the tumor is complete, the longitudinal esophageal muscle is reapproximated, although a large extramucosal defect may be left without complication. Giant leiomyomas of the cardia and adjacent stomach may require esophageal resection for their removal. When resection is complete, leiomyomas virtually never recur.

Benign polyps of the esophagus are rare and typically arise in the cervical esophagus. Most are seen in older men and are frequently attached to the cricoid cartilage. Histologically, they are composed of fibrovascular tissue with varying amounts of associated fat.