An Asymptomatic Patient with Colonic Leiomyoma

Abstract

Subepithelial lesions (SELs) originating from muscularis mucosae of the colon are very rare findings on endoscopy. Appropriate management of SELs involves making a correct diagnosis and estimating their malignant potential. In this case study, a 58-year-old Saudi man presented with a small, 8-mm sigmoid polyp during screening colonoscopy. The polyp was removed by hot snare polypectomy and sent to pathology laboratory. Report showed an unremarkable colonic mucosa and underlying well-circumscribed submucosal lesion composed of monotonous spindle cells. Immunohistochemical (IHC) analysis ruled out CD117-/DOG1-positive GIST and confirmed the lesion as leiomyomatous polyp. Colonic leiomyomas are usually benign and often asymptomatic and discovered during CRC screening procedures. Diagnosis is made on histology/IHC analysis since endoscopically they might be indistinguishable from other SELs. Conventional polypectomy is an appropriate treatment for small colonic leiomyoma and these benign lesions typically do not recur.

Colonic Leiomyoma: A Case Report of an Uncommon Endoscopic Finding

“…In the colon, most lesions are adenomas (mostly tubulo/tubulo-villous with low-grade dysplasia). Nevertheless, benign proliferations of nonepithelial cells such as those from underlying smooth muscle layers, known as leiomyomas, can arise in the colon and are typically found incidentally [4]. Small sessile polyps have been reported as the most common presentation of colonic leiomyomas; however, there have also been reports of leiomyomas of the colon presenting as firm, well-circumscribed, intraluminal, semi-pedunculated, or pedunculated polyps [6].…”

“…When the lesions present as submucosal, an endoscopic ultrasound could be useful in determining therapeutic strategies, providing valuable information on the size and extension of the tumor [3]. Moreover, flat lesions may require the use of endoscopic mucosal resection or endoscopic submucosal dissection techniques [4]. Xu et al studied 106 patients with gastrointestinal leiomyomas diagnosed through endoscopic ultrasonography (EUS) and concluded that EUS had a very important diagnostic value for gastrointestinal leiomyomas.…”

“…In these cases, they are more frequently seen in the left colon. Colonic leiomyomas are often small, asymptomatic, and discovered incidentally during routine endoscopic evaluations [3,4]. However, larger lesions can sometimes cause symptoms such as abdominal pain, intestinal obstruction, rectal bleeding, and even perforations [1,2].…”