Leiomyoma of the esophagus

Esophageal diverticula and cancer

Esophageal diverticula are rare. The association of cancer and diverticula has been described. Some authors adopt a conservative non-surgical approach in selected patients with diverticula whereas others treat the symptoms by diverticulopexy or myotomy only, leaving the diverticulum in situ. However, the risk of malignant degeneration should be may be taken in account if the diverticulum is not resected. The correct evaluation of the possible risk factors for malignancy may help in the decision making process. We performed a literature review of esophageal diverticula and cancer. The incidence of cancer in a diverticulum is 0.3-7, 1.8, and 0.6% for pharyngoesophageal, midesophageal, and epiphrenic diverticula, respectively. Symptoms may mimic those of the diverticulum or underlying motor disorder. Progressive dysphagia, unintentional weight loss, the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, melena, hemathemesis, and hemoptysis are key symptoms. Risk factors for malignancy are old age, male gender, long-standing history, and larger diverticula. A carcinoma may develop in treated diverticula, even after resection. Outcomes are usually quoted as dismal because of a delayed diagnosis but several cases of superficial carcinoma have been described. The treatment follows the same principals as the therapy for esophageal cancer; however, diverticulectomy is enough in cases of superficial carcinomas. Patients must be carefully evaluated before therapy and a long-term follow-up is advisable.

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

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.

Seedling leiomyoma of the esophagus and esophagogastric junction zone

The esophagus was totally excised for histopathological examination in 276 autopsy cases and 66 surgical cases (total, 342 cases). Leiomyoma of the esophagus was observed in 27 of the 342 cases. The tumors were present in 22 of the 225 male cases and in 5 of the 117 female cases. There were 38 leiomyomas among the 27 cases. Most of the leiomyomas originated in the inner circular muscle. None of the tumors was more than 7 mm. in length. Twenty-five of the 38 leiomyomas were located in the esophagogastric junction zone. Thus, subserial histological examination revealed leiomyomas at a higher frequency than that in previous reports.

The radiological approach to leiomyoma of the oesophagus with a long-term follow-up

Long-term follow-up of leiomyomas in the oesophagus is discussed from the radiological point of view. It is the authors' impression that surgical intervention is not a matter of urgency in the treatment of these tumours as their tendency to undergo malignant change is very rare. Nine cases of leiomyoma of the oesophagus were followed for periods ranging from 1 to 15 years. None showed malignant degeneration.

Esophageal myectomy for recurrent multiple leiomyomas of the esophagus: manometric and cineradiographic documentation

This is a report of recurrent multiple leiomyomas of the esophagus treated initially by enucleation and subsequently by myectomy of the involved portion of the esophagus to prevent further recurrence. Experimental studies support the clinical observation that the esophagus will function as a conduit for food in the absence of an orderly progression of peristalsis. Preservation of hilar truncal vagus nerve function must be accomplished if normal lower esophageal sphincter function is to be maintained. We believe this is the first report of deliberate esophageal myectomy in a human patient with manometric and cineradiographic documentation of satisfactory function postoperatively. Limited myectomy may be considered, as circumstances require, in the treatment of multiple esophageal leiomyomas, although enucleation remains the treatment of choice.

Leiomyomata of the esophagus. An analysis of 838 cases

Review of the world literature to the end of 1971 has provided data on 838 cases of esophageal leiomyomata, including our own 19 surgically removed lesions. Although esophageal leiomyoma is the most common of the benign tumors of the esophagus, it is still rare compared with carcinoma. It occurs in more men than women, by a ratio of 1.9 to 1. Over 50% of the patients with leiomyoma of the esophagus are asymptomatic. Dysphagia and vague pain are the most frequent symptoms. Pyrosis is mentioned in the literature as present in 40% of the cases, but it is considered mainly as symptom of coexistent hiatal hernia. Diagnostic problems often arise, as the smooth muscle tumors may mimic mediastinal neoplasms, cysts, or even aneurysms, or complicate coexisting hiatal hernia and esophageal diverticulum. Operative management by transthoracic enucleation is the procedure of choice, although resection of the esophagaus may be required in few cases. Postoperative morbidity is minimal and results are excellent.

Unusual presentation of a large leiomyoma of the esophagus

A case is presented with a giant pedunculated leiomyoma of the esophagus. The difficulties of diagnosis are presented along with a review of the literature. Surgical removal is safe and curative.

Intraphrenic esophageal leiomyoma associated with diverticula preoperatively diagnosed by angiography

Two cases of esophageal leiomyoma associated with diverticulum are described. Angiography demonstrated an intraphrenic location.

Diffuse leiomyomatosis of the esophagus: a case report and review of the literature

A case of diffuse leiomyomatosis of the esophagus in a 21-year-old woman with a 5-year history of dysphagia is presented. The radiological appearance was that of achalasia, but at esophagoscopy, a diagnosis of an organic stricture of the lower end of the esophagus was made. During the operation a diffuse tumor involving the lower end of the esophagus, cardia, upper portion of the stomach, and the tail of the pancreas was found. The histological diagnosis was diffuse leiomyomatosis of the esophagus. The individual characteristics of the microscopic picture are described. Distal esophagectomy and total gastrectomy resulted in complete recovery of the patient. This is a very rare condition; only a dozen similar cases have been published before. The data of these patients are presented.