Endoscopy and computed tomography in the diagnosis and follow up of oesophageal leiomyoma.

Abstract

Leiomyoma of the oesophagus, although the commonest benign oesophageal tumour, is still rare compared with malignant tumours of the oesophagus. Leiomyomas of the oesophagus are usually diagnosed on barium swallow or histological examination after section. Five cases of leiomyoma of the oesophagus are reported where diagnosis was made by the combination of barium swallow, upper gastrointestinal endoscopy, and computed tomography and all but one patient were followed up for one to four years. The endoscopic biopsy specimens were non-specific in all five patients but none showed any evidence of malignancy. None of the five patients had a history of dysphagia. This paper describes a conservative approach to medical treatment in asymptomatic oesophageal leiomyoma rather than surgical excision as commonly published. It also emphasises the importance of negative endoscopic pinch biopsy specimens and the role of computed tomography in the diagnosis of oesophageal leiomyoma.

Fine-needle aspiration cytology of esophageal leiomyomatosis

“…[2][3][4] Esophageal leiomyomata and leiomyomatosis are the most common benign tumors of the esophagus, 6,9,10,13 accounting for up to 67% of all benign esophageal tumors, but accounting for only 0.4% of all esophageal tumors. 6 There is a slight male preponderance of esophageal leiomyomata, with an average age of 44 yr. 5,6,11 Esophageal leiomyomata is rarely seen in children 10 and adolescents. 12 The lower third of the esophagus is the most common anatomic location, 6,8,9,11 with the majority of leiomyomata being single tumors and infrequently multiple tumors (leiomyomatosis).…”

“…6 Clinically, the majority of patients with esophageal leiomyoma are asymptomatic, 6,9,11,13 but when symptoms do occur, dysphagia and pain are the most common symptoms and are usually of long duration. 5,6,9,11 Endoscopy typically reveals a submucosal mass with intact mucosa. 11 Endoscopic ultrasound and CT are helpful imaging modalities.…”

“…12 The lower third of the esophagus is the most common anatomic location, 6,8,9,11 with the majority of leiomyomata being single tumors and infrequently multiple tumors (leiomyomatosis). 6,11,14 The majority of leiomyomata in children are diffuse leiomyomatosis. 10 Leiomyoma are thought to arise from the smooth muscle of the esophagus or the smooth muscle in the blood vessels of the esophagus.…”

“…10 Leiomyoma are thought to arise from the smooth muscle of the esophagus or the smooth muscle in the blood vessels of the esophagus. 11 Grossly, esophageal leiomyomata are typically firm tumors, 2-5 cm in diameter, which have a grayish-white or yellowish cut surface. 6 Microscopically, esophageal leiomyomata are characterized by bundles of smooth muscle cells with interspersed fibrous tissue.…”

Diffuse Leiomyomatosis of the Esophagus

“…Barium esophagogram, the key investigation, can provide the diagnosis in the majority of patients with esophageal leiomyoma. Esophagoscopy should be routinely performed to evaluate the integrity of the mucosa and the nature of the lesions, and to exclude the possibility of esophageal malignancy or coexistent disorders [9]. It will demonstrate a submucosal mass covered with intact mucosa and luminal narrowing of varying extent.…”