VATS resection of an oesophageal leiomyoma in a patient with neurofibromatosis Recklinghausen

Video-assisted thoracoscopic surgery for localized neurofibroma of the esophagus: case report and review of the literature

Esophageal submucosal tumors are less common than other gastrointestinal tract tumors. Leiomyoma is the most common benign esophageal SMT, accounting for more than 70% of these tumors. We report on a case of a 56-year-old woman with a 3-cm diameter midthoracic esophageal submucosal tumor. Magnetic resonance imaging suggested leiomyoma or neurofibroma. Video-assisted thoracoscopic surgery was performed to enucleate the tumor from the esophageal wall by splitting the muscle layers. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. Immunohistochemical staining confirmed the diagnosis of esophageal neurofibroma. Gastrointestinal tract involvement of neurofibromatous lesions is rare and occurs most frequently as a systemic manifestation of von Recklinghausen disease. Cases of localized esophageal neurofibroma with prior or subsequent evidence of generalized neurofibromatosis have rarely been documented. This is a rare case of isolated esophageal neurofibroma without classic systemic manifestations of generalized neurofibromatosis, and it is the first reported case treated by video-assisted thoracoscopic surgery.

Pelvic mass in von Recklinghausen's neurofibromatosis: diagnostic issues: a case report

Background

Leiomyomas are benign smooth muscle cell tumours. They are the most common uterine neoplasms, although they may also occur elsewhere, such as in the gastrointestinal and urinary tracts. Leiomyomas are uncommon in von Recklinghausen's neurofibromatosis (NF1). However, the literature suggests that the association of NF1 and leiomyomas or leiomyosarcoma is not entirely coincidental.

Case Report

We report here the unusual case of a 47-year-old woman with NF1 who presented menorrhagias and a hard, tender pelvic mass composed of uterine leiomyomas. Positron emission tomography/computed tomography disclosed an area of increased 18-fluorodeoxyglucose (FDG) uptake in the upper right part of the mass that raised the suspicion of malignancy. Magnetic resonance imaging revealed numerous intramural leiomyomas ranging from 1 to 6 cm, including a 6-cm submucosal leiomyoma that had abundant cellularity, matching FDG uptake. Abdominal hysterectomy was performed and microscopic examination confirmed the diagnosis of multiple benign smooth muscle tumours (uterine leiomyomatosis).

Conclusion

Our case illustrates several diagnostic issues that arose while exploring this pelvic mass. Moreover, the association of uterine leiomyoma and NF1 may not be fortuitous.

Thoracoscopic enucleation of a large esophageal leiomyoma using a three thoracic ports technique

Background

Video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantages over an open approach. Many papers have described various techniques of thoracoscopic resection.

Case presentation

We describe a 32-year old man who presented with intermittent dysphagia. Imaging studies showed a large esophageal leiomyoma. He underwent thoracoscopic enucleation using a three thoracic-ports technique.

Conclusion

Thoracoscopic enucleation can be technically performed using a three thoracic-ports technique.

Gastrointestinal Neurofibromatosis: An Unusual Cause of Gastric Outlet Obstruction

Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is a common autosomal dominant condition occurring in approximately 1/3000 births. NF-1 is known to be associated with gastrointestinal neoplasms in 2–25 per cent of patients. We report the first case of gastric outlet obstruction with perforation caused by neurofibroma in a patient with NF-1. The literature is reviewed, examining 61 previously reported cases of noncarcinoid gastrointestinal (GI) neoplasms in patients with NF-1 for symptoms, location, and types of neoplasms. Neoplasms were located most often in the small intestine (72%). Neurofibromas, found in 52 per cent of patients, were the most frequently diagnosed benign neoplasms followed by leiomyomas (13%), ganglioneurofibromas (9.8%), and gastrointestinal stomal tumor (GIST) (6.5%). Adenocarcinoma was present in 23 per cent of patients. Patients with NF-1 and GI symptoms are at risk for gastrointestinal neoplasms from which symptomatic patients are likely to experience significant morbidity.

Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach

BACKGROUND

Surgical enucleation of submucosal tumors (SMTs) of the esophagus (mostly leiomyomas) is indicated when either the tumors are symptomatic or their biological behavior is unclear. The classic approach is a thoracotomy, but tumor enucleation can now also be performed via thoracoscopy or, for distal tumors, via laparoscopy.

METHODS

We assessed our experience with the different approaches in a total of 25 patients (n = 13 minimally invasive approach and n = 12 open surgery). Enucleation of the SMT was the basic surgical principle; the choice of the approach was based on the preference of the surgeon.

RESULTS

Compared to open surgery, the minimally invasive approach reduced pulmonary complications, hospital stay, and postoperative wound-related pain. The operating time was the same for both approaches.

CONCLUSION

Minimally invasive approaches are suitable for the surgical enucleation of submucosal esophageal tumors. Thoracoscopic and laparoscopic techniques are recommended as standard procedures in experienced centers.

Thoracoscopic enucleation of a leiomyoma of the upper thoracic esophagus

The authors present two cases of leiomyoma of the upper esophagus. Both of the cases presented with dysphagia, and one patient complained of pyrosis. An upper gastrointestinal endoscopy showed midesophageal narrowing without mucosal irregularity, suggestive of leiomyoma. The patients were successfully treated by thoracoscopic enucleation of the leiomyoma, using four thoracic trocars. In one patient (Case 1), the azygus vein had to be divided. Both of the patients are asymptomatic in the late-postoperative period.

Video-assisted thoracic surgery for diseases within the mediastinum

VATS and concepts of minimal access thoracic surgery have revitalized many aspects of general thoracic surgery, including the surgical approach to diseases and conditions of the mediastinum. Proven surgical options that have been shunned by patients and referring physicians because of the perceived morbidity of thoracotomy have been reconsidered with the emergence of these minimal access surgical options. Continued critical review of the accumulating experience in VATS techniques will refine the surgical indications for VATS and open thoracotomy.

Thoracoscopic enucleation of an esophageal leiomyoma

A series of reports in the literature suggest that video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantage over open approach. We describe a patient with esophageal leiomyoma who underwent surgical resection via thoracoscopic approach using four thoracic trocars. The postoperative period was uneventful and the patient was discharged on postoperative day 3.