1
|
Rosca CI, Lighezan DF, Cozma GV, Branea HS, Nisulescu DD, Zus AS, Morariu SI, Kundnani NR. To Be, or Not to Be … Pectoral Angina? The Pain Is the Same, but the Etiology Is Different-A Case Report. Life (Basel) 2024; 14:1066. [PMID: 39337851 PMCID: PMC11432985 DOI: 10.3390/life14091066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/18/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Chest pain is one of the most common causes of emergency room visits and also accounts for numerous visits to the family physician's office or Outpatient Clinics of cardiology or internal medicine. CASE REPORT Here we present a case of a 48-year-old female patient who presented to our hospital emergency unit but refused hospital admission. She presented in our Outpatient Clinic with a complaint of typical chest pain indicating it to be of coronary origin. A computed tomography (CT) coronary angiography for the evaluation of this chest pain was indicated. While ruling out the coronary origin of this chest pain, we were surprised to have incidentally identified the presence of an esophageal tumor mass that had intimate contact with carina of the trachea. After the diagnosis of esophageal leiomyoma was made and its surgical treatment was performed, the patient was asymptomatic. Approximately one year after the surgical intervention was performed, following the cessation of antiplatelet therapy and statin, the patient returned to our Outpatient Clinic complaining of chest pain again with the same characteristics as previously presented, being terrified by the possibility of the recurrence of the esophageal leiomyoma. Upon resuming investigations, it was proven through coronary angio-CT evaluation that the etiology of the chest pain was indeed coronary this time. However, the patient still refused hospital admission and the performance of percutaneous coronary angiography with the potential implantation of a coronary stent. CONCLUSIONS Chest pain can be due to various underlying pathologies and should not be neglected. A thorough investigation and timely management are key to treating this possible fatal symptom. In our case, the patient presented twice with the complaint of typical chest pain indicating a possible coronary event, but at the first presentation, it was due to esophageal leiomyoma, while a year later, the patient had similar pain, which was indeed this time due to coronary blockage. Hence, it is of utmost importance to think of all possible scenarios and to investigate accordingly, leaving no stone unturned.
Collapse
Affiliation(s)
- Ciprian Ilie Rosca
- Department of Internal Medicine I—Medical Semiotics I, Centre for Advanced Research in Cardiovascular Pathology and Haemostasis, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (C.I.R.); (D.F.L.)
| | - Daniel Florin Lighezan
- Department of Internal Medicine I—Medical Semiotics I, Centre for Advanced Research in Cardiovascular Pathology and Haemostasis, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (C.I.R.); (D.F.L.)
| | - Gabriel Veniamin Cozma
- Department of Surgery I, Surgical Semiotics I and Thoracic Surgery, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
| | - Horia Silviu Branea
- Department of Internal Medicine I—Medical Semiotics II, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Daniel Dumitru Nisulescu
- General Medicine Faculty, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
- General Medicine Faculty, ”Vasile Goldiș” West University Arad, 473223 Arad, Romania
| | - Adrian Sebastian Zus
- Department VI—Cardiology, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
| | - Stelian I. Morariu
- General Medicine Faculty, ”Vasile Goldiș” West University Arad, 473223 Arad, Romania
| | - Nilima Rajpal Kundnani
- Discipline of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Department of VI Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Research Centre of Timisoara Institute of Cardiovascular Diseases, “Victor Babeș” University of Medicine and Pharmacy, 3000041 Timișoara, Romania
| |
Collapse
|
2
|
Rege SA, Dalvi AN, Churiwala JJ. MIS for enucleation of leiomyoma of the oesophagus-strategic approach and experience of 19 cases. J Minim Access Surg 2024; 20:62-66. [PMID: 37706410 PMCID: PMC10898630 DOI: 10.4103/jmas.jmas_28_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/28/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Leiomyoma of the oesophagus, although rare, is the most common benign tumour to occur in the organ. Surgical approaches have evolved over time from an open thoracotomy or laparotomy to video-assisted thoracoscopic or laparoscopic and now robotic enucleation. We report a series of 19 cases of leiomyoma of the middle- and lower-third oesophagus treated by minimally invasive surgery. PATIENTS AND METHODS A retrospective analysis of 19 cases operated at a single tertiary care centre in India was performed. After the diagnosis of a benign oesophageal neoplasm on computed tomography (CT) and endosonography, laparoscopic transhiatal enucleation of the tumour for lower third ( n = 16) and right-sided video-assisted thoracoscopic excision for middle-third tumours ( n = 3) were performed. Dor fundoplication was done after the excision of leiomyomas from the lower oesophagus. RESULTS The most common symptom at presentation was retrosternal burning in lower oesophageal tumours, while tumours in the middle third of the oesophagus were asymptomatic and incidentally detected. The size of the tumour ranged from 3 cm to 8 cm in the largest dimension on contrast-enhanced CT scan. The mean operative time was 93 min ranging from 61 to 137 min. The average blood loss was 53 ml. No patient had an iatrogenic oesophageal mucosal injury. There were no conversions to open surgery or major complications including post-operative leak or death. Post-operative recovery was uneventful. CONCLUSION The transhiatal approach to lower oesophageal leiomyomas is strategic to avoid complications of thoracoscopy, minimally invasive, cost-effective as compared to robotic surgery, suitable for adequate exposure and safe in the hands of an experienced laparoscopic surgeon.
Collapse
Affiliation(s)
- Sameer Ashok Rege
- Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | | |
Collapse
|
3
|
Peixoto A. Large incidental esophageal leiomyoma: Radiological findings. Radiol Case Rep 2022; 17:4417-4420. [PMID: 36188074 PMCID: PMC9520497 DOI: 10.1016/j.radcr.2022.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 10/28/2022] Open
|
4
|
Pan W, Wu J, Liu C, He Y, Yang J. Esophageal low-grade intraepithelial neoplasia overlying multiple leiomyomas: A case report and review of the literature. Front Oncol 2022; 12:994005. [PMID: 36387267 PMCID: PMC9659895 DOI: 10.3389/fonc.2022.994005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/03/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Esophageal leiomyoma is the most common benign submucosal mesenchymal tumor. Esophageal intraepithelial neoplasia includes low-grade and high-grade intraepithelial neoplasia. The coexistence of epithelial lesions and the subepithelial lesion is rare. We recorded a case of esophageal low-grade intraepithelial neoplasia (LGIN) overlying multiple esophageal leiomyomas and followed with a review of the literature. CASE PRESENTATION A 49-year-old female patient came for the treatment of esophageal lesions. The submucosal eminences were observed in the right posterior wall and the left anterior wall of the esophagus by Esophagogastroduodenoscopy (EGD). Additionally, we noticed the mucosa of the right wall with brown background color and the dilated, tortuous vessels by narrow-band imaging (NBI). Then we ensured that the submucosal lesions originated from the esophageal mucosal muscle by endoscopic ultrasonography (EUS) and enhanced CT. Subsequently, the submucosal eminence of the right posterior wall and the overlying mucosal lesion were removed together by endoscopic submucosal dissection (ESD). Postoperative pathological diagnosed esophageal submucosal leiomyoma with focal LGIN. Review EGD showed white scars on the right wall of the upper esophagus three months later, while pathological biopsy showed slight squamous epithelial hyperplasia in the left wall. We decided that the left submucosal lesion can be resected at a selective-time operation, and we continue to follow up as planned. CONCLUSIONS The case of intraepithelial neoplasia overlying the submucosal tumor is rare. Either missed diagnosis or overdiagnosis should be avoided through EGD and pathological biopsy.
Collapse
Affiliation(s)
- Wen Pan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
- Department of Gastroenterology and Hepatology, The Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
| | - Junchao Wu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| | - Chao Liu
- Department of Gastroenterology and Hepatology, The Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
| | - Yanjun He
- Department of Pathology, The Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
| | - Jinlin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Agarwal L, Pal S, Dash NR, Madhusudhan KS, Das P, Gunjan D, Sahni P, Chattopadhyay TK. Surgery for mesenchymal neoplasms of the esophagus: experience over 2 decades from a tertiary healthcare center in India. Updates Surg 2022; 74:1889-1899. [PMID: 36149582 DOI: 10.1007/s13304-022-01373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Mesenchymal tumors are the most common benign neoplasms of the esophagus. Owing to the rarity of these neoplasms, there is a dearth of literature regarding their diagnosis and management. Our 2-decade-long experience in managing these neoplasms surgically is presented. Relevant clinical data of all patients with esophageal mesenchymal neoplasms (EMNs) managed between January 2000 and May 2020 were retrospectively collected from a prospectively maintained esophageal diseases database in the Department of GI Surgery, AIIMS, New Delhi (India). Special emphasis was given to data pertaining to diagnostic evaluation of patients, type of surgery done (enucleation vs. resection), postoperative outcomes, histopathology and long-term follow-up. Nineteen patients (12 females; age 15-66 years) underwent surgery for EMN (mean tumor size 7.6 cm; enucleation 10; resection 9). On histopathological examination, 17 cases were noted to be benign esophageal leiomyomas and 2 were identified as gastrointestinal stromal tumors. There was no perioperative mortality. All cases were followed up for a median duration of 6 years (range 1-19 years) with no evidence of recurrence in any case. Though EMNs are uncommon, they are mostly benign, and the long-term outcomes after surgical excision are gratifying.
Collapse
Affiliation(s)
- Lokesh Agarwal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | | | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Tushar Kanti Chattopadhyay
- Department of Hepatopancreatobiliary Surgery and Liver Transplant, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| |
Collapse
|
6
|
Shi YJ, Yang X, Yan S, Li XT, Wei YY, Zhang XY, Sun YS. Primary malignant melanoma of the esophagus: differentiation from esophageal squamous cell carcinoma and leiomyoma using dynamic contrast-enhanced CT findings. Abdom Radiol (NY) 2022; 47:2747-2759. [PMID: 35668195 PMCID: PMC9300547 DOI: 10.1007/s00261-022-03556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to summarize the computed tomography (CT) findings of PMME and differentiate it from esophageal SCC and leiomyoma using CT analysis. METHODS This was a retrospective study including 23 patients with PMME, 69 patients with SCC, and 21 patients with leiomyoma in our hospital. Qualitative CT morphological characteristics of each lesion included the location, tumor range, ulcer, enhanced pattern, and so on. For quantitative CT analysis, thickness, length and area of tumor, size of largest lymph node, number of metastatic lymph node, and CT value of tumor in plain, arterial, and delayed phases were measured. The associated factors for differentiating PMME from SCC and leiomyoma were examined with univariate and multivariate analysis. Receive operating characteristic curve (ROC) was used to determine the performance of CT models in discriminating PMME from SCC and leiomyoma. RESULTS The thickness, mean CT value in arterial phase, and range of tumor were the independent factors for diagnosing PMME from SCC. These parameters were used to establish a diagnostic CT model with area under the ROC (AUC) of 0.969, and accuracy of 90.2%. In pathology, interstitial vessels in PMME were more abundant than that of SCC, and the stromal fibrosis was more obvious in SCC. PMME commonly exhibited intraluminal expansively growth pattern and SCC often showed infiltrative pattern. The postcontrast attenuation difference in maximum CT attenuation value between plain and arterial phases was the independent factor for diagnosing PMME from leiomyoma. This parameter was applied to differentiate PMME from leiomyoma with AUC of 0.929 and accuracy of 86.4%. CONCLUSION The qualitative and quantitative CT analysis had excellent performance for differentiating PMME from SCC and esophageal leiomyoma.
Collapse
Affiliation(s)
- Yan-Jie Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xin Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Shuo Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yi-Yuan Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| |
Collapse
|
7
|
Faulkner J, Vlaminck L, Geerinckx L, Raes E, Vanderperren K. Leiomyoma of the proximal cervical oesophagus in a horse. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Josephine Faulkner
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Lieven Vlaminck
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Lise Geerinckx
- Department of Pathology, Bacteriology and Poultry Disease, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Els Raes
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Katrien Vanderperren
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| |
Collapse
|
8
|
Beji H, Bouassida M, Kallel Y, Tormane MA, Mighri MM, Touinsi H. Leiomyoma of the esophagus: A case report and review of the literature. Int J Surg Case Rep 2022; 94:107078. [PMID: 35439728 PMCID: PMC9027349 DOI: 10.1016/j.ijscr.2022.107078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/17/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Benign tumors represent less than 1% of esophageal neoplasms. Esophageal leiomyoma is a very rare tumor that arises from mesenchymal tissue. We present here a case of leiomyoma of the esophagus which was revealed by dysphagia and vomiting that was treated by surgical enucleation. PRESENTATION OF CASE This report illustrates the case of a female who presented with dysphagia and vomiting. Imageology demonstrated an esophageal mass which was treated with surgical enucleation. Histopathology confirmed the diagnosis of leiomyoma. CLINICAL DISCUSSION Benign esophageal tumors are rare. Leiomyoma commonly presents as a single lesion in the middle or lower third of the esophagus. Leiomyomas located in the proximal and middle third of the esophagus can be operated on by right thoracotomy. Surgical treatment varies from enucleation to esophageal resection depending on the size and location of the mass. In our case, the tumor was enucleated by a right posterolateral thoracotomy. CONCLUSION Esophageal leiomyoma is a benign and generally asymptomatic tumor. Surgery is the pillar of treatment. Enucleation should be performed whenever possible to avoid esophagectomy and thus decrease morbidity and mortality.
Collapse
Affiliation(s)
- Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Yassine Kallel
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mohamed Amine Tormane
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mohamed Mongi Mighri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| |
Collapse
|
9
|
Elbawab H, AlOtaibi AF, Binammar AA, Boumarah DN, AlHarbi TM, AlReshaid FT, AlGhamdi ZM. Giant Esophageal Leiomyoma: Diagnostic and Therapeutic Challenges. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934557. [PMID: 34789714 PMCID: PMC8609978 DOI: 10.12659/ajcr.934557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/10/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Leiomyoma is a rare, benign, esophageal tumor that does not often measure >10 cm. Here, we report a case of giant esophageal leiomyoma in a 24-year-old man. CASE REPORT A 24-year-old man who smoked and had primary hypertension and glucose-6-phosphate dehydrogenase deficiency presented with a history of shortness of breath and productive cough with yellowish sputum, a long history of dysphagia to solid food, and a weight loss of 7 kg over 2 months. A chest X-ray revealed a mediastinum with a width >8 cm. Computed tomography of the patient's chest revealed a multilobulated mass that originated from the upper and middle thoracic esophagus, caused severe narrowing of his esophageal lumen, and was compressing his trachea and right main bronchus. Resection of the tumor was performed and, because of the large defect after the surgery and the mucosal necrosis, the patient underwent an Ivor-Lewis esophagectomy. His postoperative course was uneventful. He had no symptoms when he was seen in the outpatient clinic for follow-up and fully recovered. CONCLUSIONS Giant esophageal leiomyoma (GEL) is a rare oncological entity that presents several diagnostic and therapeutic challenges because of the scarcity of information in the medical literature on surgical management. The descriptions of techniques for surgical resection of GEL do not include ways to effectively perform subsequent reconstruction. The aim of the present paper was to contribute to this scant information by reporting our experience with performing an Ivor-Lewis esophagectomy to manage a case of GEL.
Collapse
Affiliation(s)
- Hatem Elbawab
- Thoracic Unit, Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Ammar A. Binammar
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dhuha N. Boumarah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Turki Muslih AlHarbi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Farouk T. AlReshaid
- Thoracic Unit, Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zeead M. AlGhamdi
- Thoracic Unit, Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
10
|
Wong T, Pattarapuntakul T, Keeratichananont S, Cattapan K, Nirattisaikul S, Wetwittayakhlung P. Multiple Esophageal Leiomyoma Presenting with Clinical Dysphagia from Mechanical Obstruction and Motility Disorder. Case Rep Gastroenterol 2021; 15:861-868. [PMID: 34720836 PMCID: PMC8543276 DOI: 10.1159/000518861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Esophageal leiomyoma is uncommon. However, this tumor is the most common subepithelial tumor affecting the esophagus, comprising approximately two-thirds of benign esophageal tumors. Leiomyomas of the esophagus rarely cause symptoms when they are single and <5 cm. The mainstay of treatment is esophagectomy for symptomatic patients. A 68-year-old male patient presented with progressive dysphagia for 4 months. The degree of dysphagia and chest discomfort was more severe on solid rather than liquid diet. The CT scan of the chest showed multiple well-defined, submucosal nodules, up to 1.9 cm in diameter located at the middle esophagus. The barium swallow study illustrated multiple, well-defined, smooth, semilunar filling defects along the mid to distal esophagus. Meanwhile, esophagogastroduodenoscopy revealed 8 smooth subepithelial masses. Moreover, the radial EUS showed multiple hypoechoic masses arising from the 4th layer, with some of the tumors connected to others as a horseshoe-like shape causing narrowed lumen. Last, high-resolution esophageal manometry revealed ineffective esophageal motility. We report a rare case of numerous esophageal leiomyomas which caused dysphagia as a result of both mechanical obstruction and hypomotility disorder. The histopathology confirmed the diagnosis of esophageal leiomyoma. Symptoms improved significantly after lifestyle modifications and adherence to dietary advice on the part of the patient.
Collapse
Affiliation(s)
- Thanawin Wong
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Songklanagarind hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanawat Pattarapuntakul
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Songklanagarind hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Suriya Keeratichananont
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kamonwon Cattapan
- Department of Radiology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sitang Nirattisaikul
- Department of Radiology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Poowadon Wetwittayakhlung
- Department of Anatomical pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
11
|
Zhao L, Zhang X, Gao C, He J, Han Z, Li L. A comparison of bronchial blocker under artificial pneumothorax and double-lumen endobronchial tube for lung isolation in thoracoscopic enucleation of oesophageal leiomyoma. J Cardiothorac Surg 2021; 16:322. [PMID: 34719379 PMCID: PMC8559383 DOI: 10.1186/s13019-021-01707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Oesophageal leiomyomas are one of the most common benign oesophageal tumours. This retrospective, observational study summarized and compared the clinical outcomes of thoracoscopic enucleation of oesophageal leiomyoma between single-lumen endotracheal intubation with a bronchial blocker and double-lumen endotracheal intubation. Methods A total of 36 patients who underwent thoracoscopic enucleation of oesophageal leiomyoma at Peking Union Medical College Hospital between 2014 and 2020 were retrospectively analysed. Fifteen patients received single-lumen endotracheal intubation combined with a right bronchial blocker (SLT-B group), and twenty-one patients received double-lumen endotracheal intubation (DLT group). Clinical data, surgical variables, and postoperative complications were analysed and compared. Results The average tumour size in all patients was 4.3 ± 2.0 cm. The average tumour size among symptomatic patients was significantly larger than that among asymptomatic patients (5.1 ± 2.0 cm vs 3.7 ± 1.7 cm, P < 0.05). Patients in the SLT-B group had a significantly larger average tumour size than patients in the DLT group (5.4 ± 2.1 cm vs 3.5 ± 1.4 cm, P < 0.05). The SLT-B group had a significantly shorter operation time and shorter total hospital stay than the DLT group. No mucosal injury, conversion to thoracotomy, or other operative complications occurred in the SLT-B group. In the follow-up, no recurrence, dysphagia, or regurgitation was found in any of the patients. Conclusions Compared with traditional double-lumen intubation, artificial pneumothorax-assisted single-lumen endotracheal intubation combined with a bronchial blocker for thoracoscopic oesophageal leiomyoma enucleation can achieve complete removal of larger tumours, with fewer complications and shorter hospital stays.
Collapse
Affiliation(s)
- Luo Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xue Zhang
- Department of Anaesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, 100730, China
| | - Chao Gao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jia He
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zhijun Han
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
12
|
Biswas P, Kalikar V, Majeed T, Patankar R. Giant leiomyoma in distal, intra-thoracic oesophagus: Is laparoscopic approach feasible? INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii200049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pratik Biswas
- Department of Digestive Diseases, Zen Hospital, Chembur, India
| | | | - Tanveer Majeed
- Department of Digestive Diseases, Zen Hospital, Chembur, India
| | - Roy Patankar
- Department of Digestive Diseases, Zen Hospital, Chembur, India
| |
Collapse
|
13
|
Padmanabhan N, Kurian A, Hussain A, Rajarajan V, Pai A. Giant Gastroesophageal Leiomyoma: Challenges in Diagnosis and Management. J Gastrointest Cancer 2021; 51:1039-1043. [PMID: 32144541 DOI: 10.1007/s12029-020-00387-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Naveen Padmanabhan
- Department of Surgical Oncology, Apollo Cancer Institutes, No. 35, Padma Complex, Anna Salai, Chennai, 600035, India.
| | - Ann Kurian
- Department of Pathology, Apollo Cancer Institutes, Chennai, 600035, India
| | - Aasim Hussain
- Department of GI Surgery, Apollo Cancer Institutes, Chennai, 600035, India
| | - V Rajarajan
- Department of Vascular Surgery, Apollo Hospitals, Chennai, 600035, India
| | - Ajit Pai
- Department of Surgical Oncology, Apollo Cancer Institutes, No. 35, Padma Complex, Anna Salai, Chennai, 600035, India
| |
Collapse
|
14
|
Rao M, Meng QQ, Gao PJ. Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography–fine needle aspiration: A case report. World J Clin Cases 2020; 8:5809-5815. [PMID: 33344578 PMCID: PMC7716314 DOI: 10.12998/wjcc.v8.i22.5809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Benign esophageal tumors are rare accounting for < 1% of esophageal tumors; two-thirds of which are leiomyomas. Esophageal leiomyoma is a benign tumor derived from mesenchymal tissue that is completely muscularly differentiated. Most esophageal leiomyomas are < 5 cm. Esophageal leiomyomas > 5 cm are rare. We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.
CASE SUMMARY A 35-year-old woman presented to the doctor because of a choking sensation after eating. Physical examination showed no positive signs. Gastroscopy indicated an uplifted change in the cardia. Enhanced computed tomography revealed space-occupying lesions in the lower part of the esophagus and cardia, which were likely to be malignant. Positron emission tomography–computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia. Malignant lesions were considered, and mesenchymal tumors were not excluded. Endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus, which was unclear from the esophageal wall. Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors. Finally, histological specimens obtained by endoscopic ultrasonography– fine needle aspiration suggested leiomyoma. The patient underwent laparoscopic local resection of the tumor. The postoperative pathological diagnosis was leiomyoma.
CONCLUSION Endoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas. It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.
Collapse
Affiliation(s)
- Min Rao
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Qing-Qing Meng
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Pu-Jun Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
15
|
Smooth Muscle Conditions of the Chest: A Clinical, Radiologic, and Pathologic Review. J Thorac Imaging 2020; 36:263-278. [PMID: 33165163 DOI: 10.1097/rti.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected.
Collapse
|
16
|
Thakut G, Murchite SA, Kulkarni RM, Gaikwad VV. Leiomyoma of esophagus-A case report. Int J Surg Case Rep 2020; 76:285-287. [PMID: 33059207 PMCID: PMC7566076 DOI: 10.1016/j.ijscr.2020.09.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/19/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Benign tumors of the esophagus are rare. However, among them, leiomyomas are common. Tumors larger than 5 cm are rare and may present as dysphagia or epigastric pain. Combined esophagoscopy and video-assisted thoracoscopic surgery or laparoscopic trans hiatal resection are used the management of leiomyoma of esophagus. PRESENTATION OF CASE This case report illustrates the case of a young male who presented with dysphagia and occasional dyspnea. Imageology demonstrated an esophageal mass which on surgical exploration and histopathology, confirmed the diagnosis of leiomyoma. DISCUSSION Esophageal leiomyomas vary in their presenting size from a few centimeters to greater than 5 cm which are rare. The preferred surgical technique for leiomyomas is transthoracic enucleation without opening the mucosa, which is easier, faster, and safer compared to resection. In our patient, due to the size and location of the tumor, it was resected using an abdominal approach, and a distal esophagectomy and esophagogastrostomy were performed. CONCLUSION A multi-modal approach involving both the endoscopic and radiologic examinations is crucial in ensuring that the morbidity of malignancy is avoided.
Collapse
Affiliation(s)
- Gowtham Thakut
- Department of General Surgery, D. Y. Patil Medical College, Kolhapur, Maharashtra, 416006, India.
| | - Sheetal A Murchite
- Department of General Surgery, D. Y. Patil Medical College, Kolhapur, Maharashtra, 416006, India.
| | - Rajendra M Kulkarni
- Department of General Surgery, D. Y. Patil Medical College, Kolhapur, Maharashtra, 416006, India.
| | - Vaishali V Gaikwad
- Department of General Surgery, D. Y. Patil Medical College, Kolhapur, Maharashtra, 416006, India.
| |
Collapse
|
17
|
Milito P, Asti E, Aiolfi A, Zanghi S, Siboni S, Bonavina L. Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction. J Gastrointest Surg 2020; 24:499-504. [PMID: 30941689 DOI: 10.1007/s11605-019-04210-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Minimally invasive enucleation is the treatment of choice in symptomatic patients with esophageal leiomyoma. Comprehensive long-term follow-up data are lacking. Aim of this study was to review the clinical outcomes of three procedures for enucleation of leiomyoma of the esophagus and esophagogastric junction. METHODS A single institution retrospective review was performed using a prospectively collected research database and individual medical records. Demographics, presenting symptoms, use of proton-pump inhibitors (PPI), tumor location and size, treatment modalities, and subjective and objective clinical outcomes were recorded. Barium swallow and upper gastrointestinal endoscopy were routinely performed during the follow-up. Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Short-Form 36 questionnaires were used to compare quality of life before and after treatment. RESULTS Between 2002 and 2017, 35 patients underwent minimally invasive leiomyoma enucleation through thoracoscopy (n = 15), laparoscopy (n = 15), and endoscopy (n = 5). The overall morbidity rate was 14.3% and there was no mortality. All patients had a minimum of 1-year follow-up. The median follow-up was 49 (IQR 54) months, and there were no recurrences of leiomyoma. At the latest follow-up, the SF-36 scores were unchanged compared to baseline. However, there was a higher incidence of reflux symptoms (p < 0.050) and PPI use (p < 0.050) after endoscopic treatment. CONCLUSIONS Minimally invasive enucleation is safe and effective and can be performed by a variety of approaches according to leiomyoma location and morphology. Overall, health-related quality of life outcomes of each procedure appear satisfactory, but PPI dependence was greater in the endoscopic group.
Collapse
Affiliation(s)
- Pamela Milito
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Simone Zanghi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. .,Divisione Universitaria di Chirurgia, IRCSS Policlinico San Donato, Piazza E. Malan 2, 20097 San Donato Milanese, Milan, Italy.
| |
Collapse
|
18
|
Val-Bernal JF, Martino M, Terán A, Yllera E, Castro-Senosiain B. Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of leiomyomas of the gastrointestinal tract. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2019; 52:154-162. [PMID: 31213256 DOI: 10.1016/j.patol.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/02/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
We investigated the efficiency and accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) in the diagnosis of gastrointestinal leiomyoma (GIL). Between January 2009 and May 2018 we performed 795 EUS-FNAC studies of lesions of the gastrointestinal (GI) tract for various clinical indications. A diagnosis of GIL by cytological and cell block study was made in 14 patients (57.1% males, mean age 53.6 years, range 22-84 years). 7 tumors (50%) were detected incidentally. The lesions ranged in size from 2 to 10cm (mean size 4.4cm). The location of the tumors was: esophagus 7 (50%), stomach 6 (42.9%) and rectum 1(7.1%). The mean size of the symptomatic tumors was 5.2cm (range 3-10cm). The follow-up of the 14 patients varied from 1 to 108 months (median 39.5 months), during which no recurrence or evidence of lesion progression was observed. Imaging alone was not sufficient for an accurate diagnosis to be made. The pathological diagnosis was based on a combination of cytological, histopathological, and immunohistochemical features. The intracytoplasmic eosinophilic globule is a useful marker of paucicellular GIL differentiating it from gastrointestinal stromal tumor and leiomyosarcoma. EUS-FNAC is a reliable, accurate, and safe method for the diagnosis of GIL.
Collapse
Affiliation(s)
- José-Fernando Val-Bernal
- Pathology Unit, Medical and Surgical Sciences Department, University of Cantabria and IDIVAL Research Institute, Santander, Spain.
| | - María Martino
- Anatomical Pathology Service, Marqués de Valdecilla University Hospital, University of Cantabria and IDIVAL Research Institute, Santander, Spain
| | - Alvaro Terán
- Digestive Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Elena Yllera
- Radiodiagnostic Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | | |
Collapse
|
19
|
Drobyazgin EA, Chikinev YV, Sudovykh IE, Marchenko AA, Khusainov VF. [Diagnostics and treatment of patients with giant leiomyoma of the esophagus]. Khirurgiia (Mosk) 2019:47-53. [PMID: 31825342 DOI: 10.17116/hirurgia201912147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diagnostics and surgical treatment of 2 patients with giant esophageal leiomyoma are reported. The diagnosis was confirmed by chest computed tomography, MRI of the mediastinum, endoscopic ultrasound. Resection of tumor with mucosa suturing and Nissen fundoplication was performed in 1 case. There were no intraoperative complications. Postoperative partial failure of the seams of the esophageal wall occurred in 1 case. Drainage of posterior mediastinum was performed. Treatment resulted closure of the esophageal wall defect. Control postoperative examination confirmed patent esophagus and preserved passage through the esophagus. Multidisciplinary approach to diagnosis and treatment of these patients results favorable outcomes.
Collapse
Affiliation(s)
- E A Drobyazgin
- Novosibirsk State Medical University of the Ministry of Health, Novosibirsk, Russia; Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - Yu V Chikinev
- Novosibirsk State Medical University of the Ministry of Health, Novosibirsk, Russia; Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - I E Sudovykh
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - A A Marchenko
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - V F Khusainov
- Novosibirsk State Medical University of the Ministry of Health, Novosibirsk, Russia
| |
Collapse
|
20
|
Xu H, Li Y, Wang F, Wang W, Zhang L. Video-Assisted Thoracoscopic Surgery for Esophageal Leiomyoma: A Ten-Year Single-Institution Experience. J Laparoendosc Adv Surg Tech A 2018; 28:1105-1108. [PMID: 30067130 DOI: 10.1089/lap.2018.0412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study was a 10-year single-institution experience with surgery for esophageal leiomyomas comparing a minimally invasive approach to thoracotomy. MATERIALS AND METHODS A retrospective review of patients who underwent resection of esophageal leiomyomas between 2008 and 2017 was conducted. Information on demographic features, symptoms, the operative approach, and complications was recorded. RESULTS Fifty-six patients were enrolled. Forty patients underwent an open surgical approach, and 16 patients were treated using thoracoscopy. There was no postoperative mortality or esophageal leakage. Five patients required the repair of a mucosal injury during resection. There were no statistically significant differences in operative time, blood loss, chest tube duration, or the length of postoperative stay between the video-assisted thoracoscopic surgery (VATS) group and the thoracotomy group. The mean tumor size in the thoracotomy group was larger than that in the VATS group (3.63 ± 2.15 versus 2.23 ± 1.30, P = .01). CONCLUSIONS Thoracoscopic enucleation is a safe and effective treatment for esophageal leiomyoma.
Collapse
Affiliation(s)
- Hao Xu
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Yi Li
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Fei Wang
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Wei Wang
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| |
Collapse
|
21
|
Shang QX, Yang YS, Wang WP, Hu WP, Chen LQ. Missed diagnosis of esophageal leiomyoma leading to esophagectomy: a case report and review of literatures. J Thorac Dis 2018; 10:E65-E69. [PMID: 29600107 DOI: 10.21037/jtd.2017.12.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Leiomyomas are the most common benign esophageal neoplasm. About half of them were smaller than 5 cm and asymptomatic with a stable size for many years. Esophageal leiomyomas that excess than 5 cm in size may develop as a consequence of giant one at rapid growth rate. This case report specifically describes a mid-aged woman who experienced a missed diagnosis of an esophageal leiomyoma over three years, which was covered by mediastinal thymolipoma and it subsequently developed as a giant tumor occupying the entire esophagus that makes the simple enucleation impossible. A surgical intervention of esophagectomy had to be performed to manage this entity.
Collapse
Affiliation(s)
- Qi-Xin Shang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wei-Peng Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| |
Collapse
|
22
|
Kohli DR, Faigel DO. Esophageal leiomyomas: Making mole hills out of mole hills? Gastrointest Endosc 2018; 87:378-379. [PMID: 29406926 DOI: 10.1016/j.gie.2017.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| |
Collapse
|
23
|
Perwaiz A, Shaw VK, Singh A, Chaudhary A. Extra-mucosal enucleation is still a safe and feasible treatment option of giant esophageal leiomyomas. Indian J Gastroenterol 2018; 37:63-66. [PMID: 29464545 DOI: 10.1007/s12664-018-0835-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/12/2018] [Indexed: 02/07/2023]
Abstract
Esophageal leiomyoma (EL) is rare but still the most common benign tumor of the esophagus. Extra-mucosal enucleation (EME) is the treatment of choice. Many recent reports have favored esophageal resection for giant Esophageal leiomyomas (ELs). The consequence of esophageal resection is well known and it would be radical to consider it as a preferred treatment for giant EL since most of them are still benign. We share case series of five giant ELs managed by EME, avoiding a mucosal breach and hence avoiding potentially morbid esophageal resections.
Collapse
Affiliation(s)
- Azhar Perwaiz
- Department of GI Surgery, GI Oncology, MAS and Bariatric Surgery, Medanta, The Medicity, Sector 38, Gurgaon, 122 018, India.
| | - Vinay Kumar Shaw
- Department of GI Surgery, GI Oncology, MAS and Bariatric Surgery, Medanta, The Medicity, Sector 38, Gurgaon, 122 018, India
| | - Amanjeet Singh
- Department of GI Surgery, GI Oncology, MAS and Bariatric Surgery, Medanta, The Medicity, Sector 38, Gurgaon, 122 018, India
| | - Adarsh Chaudhary
- Department of GI Surgery, GI Oncology, MAS and Bariatric Surgery, Medanta, The Medicity, Sector 38, Gurgaon, 122 018, India
| |
Collapse
|
24
|
Laparoscopic approach in the treatment of large leiomyoma of the lower third of the esophagus. Wideochir Inne Tech Maloinwazyjne 2017; 12:437-442. [PMID: 29362660 PMCID: PMC5776493 DOI: 10.5114/wiitm.2017.72327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023] Open
Abstract
Leiomyoma of the lower third of the esophagus is a relatively rare disorder but the most common benign tumor of the esophagus. We present a case of an involuted esophageal leiomyoma, 11 cm in size, treated by the laparoscopic approach. The preoperative computed tomogram visualized a mass 3 × 1.5 cm in diameter in the lower esophagus without an eccentric lumen or compression of nearby organs. Resection of the tumor was indicated according to the patient‘s symptoms and to exclude malignancy. Laparoscopic enucleation of esophageal leiomyoma was performed. The overall operative time was 205 min. The diagnosis of leiomyoma was established on histopathology and immunohistochemistry staining. The patient resumed the intake of a normal diet on the 5th postoperative day and was discharged from hospital 8 days after the surgery. We have found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon.
Collapse
|
25
|
Sun LJ, Chen X, Dai YN, Xu CF, Ji F, Chen LH, Chen HT, Chen CX. Endoscopic Ultrasonography in the Diagnosis and Treatment Strategy Choice of Esophageal Leiomyoma. Clinics (Sao Paulo) 2017; 72:197-201. [PMID: 28492717 PMCID: PMC5401615 DOI: 10.6061/clinics/2017(04)01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/26/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES: Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions. METHODS: Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis. RESULTS: One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (p<0.05). SMA (smooth muscle antibody) (97.2%) and desmin (94.5%) were positive in the majority of patients. In terms of treatments, patients preferred endoscopic therapies, which led to less adverse events (e.g., intraoperative bleeding, local infection, pleural effusion) than surgical operations (p<0.05). The superficial leiomyomas presented less adverse events and better recovery (p<0.05) than deep leiomyomas. CONCLUSION: Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely avoid misdiagnosis, so combining it with other examinations may be a good strategy to solve this problem.
Collapse
Affiliation(s)
- Ling-Jia Sun
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
- Department of Gastroenterology, Ningbo No. 2 Hospital, Zhejiang, China
| | - Xin Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Yi-Ning Dai
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Cheng-Fu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Li-Hua Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
| | - Chun-Xiao Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Zhejiang, China
- *Corresponding author. E-mail:
| |
Collapse
|
26
|
A Foregut Duplication Cyst of the Stomach in Association with a Gastrointestinal Stromal Tumor and a Leiomyoma: A Case Report. Case Rep Pathol 2016; 2016:1537240. [PMID: 28097030 PMCID: PMC5209591 DOI: 10.1155/2016/1537240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/01/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives. Duplication cysts are rare benign lesions usually arising in the gastrointestinal tract. We report a case of a 52-year-old woman with an incidental gastric mass found on computed tomography during a pregraft workup for a familial cardiomyopathy. Methods. The mass was completely excised by partial gastrectomy and gross examination revealed a cystic lesion containing two small solid nodules in its wall. Microscopic evaluation and immunohistochemistry study were performed to further characterize the cyst and the nodules. A comprehensive literature review of the NCBI database PubMed was also carried out. Results. While the cyst was diagnosed as a foregut duplication cyst, the solid nodules proved to be concomitant gastrointestinal stromal tumor (GIST) and leiomyoma. Both morphologic features and immunohistochemistry stains, including CD117, smooth muscle actin, and CD34 supported the diagnosis. Clinical course was benign and the patient had no clinical evidence of relapse ten months following the surgical procedure. The literature search did not reveal any other published case of a foregut duplication cyst presenting in combination with a GIST and a leiomyoma. Conclusions. To our knowledge, this is the first case of a composite lesion comprising a foregut duplication cyst of the stomach along with a leiomyoma and a GIST.
Collapse
|
27
|
Concurrent esophageal dysplasia and leiomyoma. Case Rep Gastrointest Med 2014; 2014:804175. [PMID: 25093127 PMCID: PMC4100387 DOI: 10.1155/2014/804175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/06/2014] [Indexed: 01/22/2023] Open
Abstract
Esophageal leiomyomas (ELMs) are rare but described in the literature. They are usually benign and do not require resection unless they are large and symptomatic. Most of such masses arise from the muscularis mucosa. It is very uncommon to find epithelial dysplasia overlying a subepithelial leiomyoma. A review of the literature reveals only one prior case of ELM with an overlying epithelia dysplasia and here we report a second case.
Collapse
|
28
|
Todaro P, Crinò SF, Ieni A, Pallio S, Consolo P, Tuccari G. Intraparietal esophageal leiomyomas diagnosed by endoscopic ultrasound-guided fine-needle aspiration cytology: Cytological and immunocytochemical features in two cases. Oncol Lett 2014; 8:123-126. [PMID: 24959231 PMCID: PMC4063574 DOI: 10.3892/ol.2014.2077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/27/2014] [Indexed: 02/07/2023] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) has proven to be of significant value as a diagnostic method for the evaluation of esophageal mesenchymal tumors, such as true leiomyomas. Utilizing the cell block procedure, the present study reports the diagnostic approach of EUS-FNAC in two patients affected by this lesion, describing the cytological and immunocytochemical findings. Spindle-shaped elements with elongated nuclei were appreciable; moreover, the cytoplasmatic immunohistochemical positivity for smooth muscle actin and desmin strongly supported the diagnosis of leiomyoma when also taking into account the constant negativity for CD34, CD117 and S100. The differential diagnosis between spindle cell mesenchymal tumors and leiomyomas, and the clinico-therapeutic management of the latter are also discussed in the study.
Collapse
Affiliation(s)
- P Todaro
- Department of Human Pathology 'Gaetano Barresi', University of Messina, Messina, I-98125 Italy
| | - S F Crinò
- Digestive Endoscopy Unit, Hospital Health Network 'Polyclinic G. Martino', University of Messina, Messina, I-98125 Italy
| | - A Ieni
- Department of Human Pathology 'Gaetano Barresi', University of Messina, Messina, I-98125 Italy
| | - S Pallio
- Digestive Endoscopy Unit, Hospital Health Network 'Polyclinic G. Martino', University of Messina, Messina, I-98125 Italy
| | - P Consolo
- Digestive Endoscopy Unit, Hospital Health Network 'Polyclinic G. Martino', University of Messina, Messina, I-98125 Italy
| | - G Tuccari
- Department of Human Pathology 'Gaetano Barresi', University of Messina, Messina, I-98125 Italy
| |
Collapse
|
29
|
Giant oesophageal leiomyoma as a diagnostic and therapeutic problem - a case report. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:79-82. [PMID: 26336401 PMCID: PMC4283910 DOI: 10.5114/kitp.2014.41938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/06/2013] [Accepted: 12/20/2013] [Indexed: 11/17/2022]
Abstract
Oesophageal leiomyoma is a rare benign tumour of the oesophagus, which does not cause clinical symptoms in more than half of cases. Below we present the case of a symptomless oesophageal tumour. Due to the unequivocal result of imaging examinations and no histopathological diagnosis the patient was qualified for thoracotomy. During the operation the oesophageal tumour was suspected of passing through the hiatus into the abdominal cavity. The specimen revealed a neoplasm of mesenchymal origin without distinct traits of malignancy. The patient was admitted to the Surgical Department, where she was qualified for surgery, which was carried out by a team of surgeons and thoracic surgeons. The encapsulated tumour and oesophagus were resected. The histopathological and immunohistochemical examinations corres ponded to leiomyoma oesophagi. The lesion was radically resected. The size of the lesion was 22 × 14 × 13 cm. Three months after the surgery no traits of relapse were found.
Collapse
|
30
|
Leiomyoma of the gastrointestinal tract with interstitial cells of Cajal: a mimic of gastrointestinal stromal tumor. Am J Surg Pathol 2014; 38:72-7. [PMID: 24145645 DOI: 10.1097/pas.0b013e3182a0d134] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Leiomyomas (LMs) of the gastrointestinal tract arise within the muscularis mucosae (superficial) and muscularis propria (deep). There are isolated reports of KIT-positive cells, presumed interstitial cells of Cajal (ICCs), within gastrointestinal LMs. We have encountered esophageal LMs with a high proportion of KIT-positive and DOG1-positive spindle-shaped cells, an appearance that mimicked gastrointestinal stromal tumor. Our aim was to explore the prevalence of ICCs in LMs of the gastrointestinal tract and the etiopathogenic significance of these cells in this benign neoplasm. We identified 34 esophageal LMs (28 deep, 6 superficial), 8 gastric LMs, and 5 small-bowel LMs (all lesions in muscularis propria). We performed immunohistochemical staining studies for desmin, DOG1, and KIT on these neoplasms. We also evaluated 12 superficial colonic LMs. ICCs were distinguished from mast cells on the basis of morphology (elongated and occasionally branching spindle-shaped cells) and the presence of DOG1 reactivity. Four cases were screened for mutations in PDGFRA exons 12, 14, and 18 and KIT exons 9, 11, 13, and 17. ICCs were identified in all deep esophageal LMs and constituted an average of 20% of the lesional cells; focally, these cells comprised >50% of cells. The density of these cells was significantly higher than the background muscularis propria, and hyperplasia of ICCs was not identified in the adjacent muscle. ICCs were identified in 6 of 8 gastric LMs and 1 of 5 small-bowel LMs and were entirely absent in all superficial esophageal and colonic/rectal LMs. There were no mutations in KIT or PDGFRA. ICCs are universally present in deep esophageal LMs, and thus these neoplasms could be mistaken for gastrointestinal stromal tumors, particularly on biopsy samples, an error associated with adverse clinical consequences. ICCs are also identified in gastric and intestinal LMs, albeit in a smaller proportion of cases. Colonization and hyperplasia by non-neoplastic ICCs likely account for this phenomenon.
Collapse
|
31
|
Walters DM, Vaughn NH, Isbell JM, Jeffus SK, Atkins KA, Sauer BG, Jones DR. Leiomyoma presenting as a massive calcified circumferential esophageal mass. Ann Thorac Surg 2013; 96:1851-4. [PMID: 24182472 DOI: 10.1016/j.athoracsur.2013.01.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 12/30/2012] [Accepted: 01/28/2013] [Indexed: 12/25/2022]
Abstract
Esophageal leiomyoma is the most common benign esophageal neoplasm and often presents as an incidental finding or with nonspecific symptoms such as dysphagia or chest pain. Surgical enucleation is the mainstay of treatment and may be accomplished using both open and thoracoscopic approaches. We present a case of a 57-year-old man who presented with a massive circumferential calcified leiomyoma.
Collapse
Affiliation(s)
- Dustin M Walters
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | | | | | | | | | | |
Collapse
|
32
|
Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma. Surg Endosc 2013; 27:4259-66. [PMID: 23955726 DOI: 10.1007/s00464-013-3035-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/10/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Esophageal leiomyoma is benign and often asymptomatic, but if the tumor is too large or obstructive, it should be resected. The aim of this study was to compare a novel approach, endoscopic submucosal tunnel dissection (ESTD), with a more established method, endoscopic submucosal dissection (ESD). METHODS This was a retrospective study of 39 patients in Chongqing Xinqiao Hospital, China, undergoing resection for leiomyoma >2 cm in diameter, or 1.5-2.0 cm in diameter with symptoms of obstructive dysphagia. Epidemiological data, presenting symptoms, diagnostic investigations, tumor location, histopathological findings, and safety and efficacy of surgical resection were analyzed. RESULTS Mean tumor sizes in the ESTD (n = 18; mean age = 36.7 ± 6.3 years) and ESD (n = 21; age = 41.0 ± 4.4 years) groups were 3.3 ± 0.7 and 3.0 ± 0.4 cm, respectively. The male:female ratio was 25:14, with a distribution of lesions among the lower, middle, and upper esophagus of 22:14:3. Operating time was significantly shorter (p < 0.05) for ESTD (67.5 ± 9.5 min) than for ESD (87.2 ± 7.7 min), while incision healing was faster (p < 0.05) for ESTD (14.7 ± 2.5 days) than for ESD (57.9 ± 7.5 days). Hospital stay was also shorter (p < 0.05) for ESTD (2.3 ± 0.5 days) than for ESD (5.7 ± 1.0 days). Bleeding was the only complication with ESTD (3/18 patients), with no significant difference in the incidence of complications between groups. ESTD was rapidly learned by surgeons. CONCLUSION ESTD is a safe and effective treatment for esophageal leiomyoma, with advantages over ESD.
Collapse
|