Coexistence of esophageal superficial carcinoma and multiple leiomyomas: A case report

Abstract

Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-year-old man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient's severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas (20 lesions, up to 3 cm in diameter), and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be misdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.

Invasion of Esophageal Leiomyoma by Coexistent Overlying Squamous Cell Carcinoma

“…Occasionally, in about 2.4% of patients, more than one leiomyoma may occur in the esophagus of the same patient. Presence of esophageal SCC coexisting with multiple leiomyoma is very rare [1].…”

“…The most common benign tumor of the esophagus is leiomyoma [1]. However, the coexistence of this tumor and squamous cell carcinoma (SCC) in the same esophagus has rarely been reported [2].…”

Esophageal Squamous Cell CarcinomaIn SituOverlying Leiomyoma Mimicking Invasive Cancer: A Brief Case Report

“…Regarding their coexistence, however, squamous cell carcinoma and submucosal leiomyoma have been reported as either the overlying type or the separated type 1. Cases with squamous cell carcinoma overlying leiomyoma are extremely rare, and there have only been 15 cases reported, to our knowledge 1,2,3,4,5. All fifteen cases were male.…”

Multiple solitary leiomyomas in the esophagus: Report of a case

“…Microscopically, the nodules have histological fi ndings typical of leiomyomas, i.e., a low overall cellularity, and an increased growth from interlaced smooth muscle cells with hypovascularity. 11 Although more than one tumor (generally two or three) is occasionally found in the same patient (<2.4% of cases), only four reported cases have presented with more than eight lesions (Table 1). Bradford et al 12 reported 14 leiomyomas, averaging 1-4 cm, in the same patient.…”

“…Seremetis et al 3 reported on a patient with 15 independent esophageal leiomyomas, in whom enucleation of the lesions was successful. Iwaya et al 11 encountered a patient with more than 20 leiomyomas, accompanied by esophageal carcinoma overlying the submucosal leiomyoma. However, the molecular mechanisms responsible for the development of multiple solitary leiomyomas still remain to be fully elucidated.…”