Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

An Uncommon Occurrence of Rectal Leiomyoma: A Case Report and Literature Review

Gastrointestinal (GI) leiomyomas, particularly those located in the rectum, are extremely rare, accounting for approximately 0.1% of rectal tumors. We report the case of a middle-aged female who presented with chronic diarrhea of unknown origin. A colonoscopy was performed, during which a rectal polyp was resected. Histopathology examination of the polyp revealed smooth muscle proliferation and a positive immunohistochemical profile for desmin, consistent with leiomyomatous nature and a diagnosis of rectal leiomyoma. This case underscores the importance of a comprehensive diagnostic approach, including endoscopic, histologic, and immunohistochemical analysis, to differentiate leiomyomas from other GI tumors. Following GI evaluation, the patient underwent a total abdominal hysterectomy, which revealed multiple uterine leiomyomas. The concurrent presence of rectal and uterine leiomyomas in this patient is significant and suggests a potential association between these lesions in females. Further research is needed to explore the potential relationship between rectal and uterine leiomyomas and its implications for clinical practice.

Descending Colon Leiomyoma: A Case Report and Literature Review

Leiomyoma is defined as a benign proliferation of smooth muscle cells. Smooth muscle tumors are considered the second-most common mesenchymal neoplasm in the gastrointestinal (GI) tract. It typically occurs incidentally in the large bowel. Colonic leiomyomas are considered to be very rare and commonly found in the descending or sigmoid colon. We report a case of a 32-year-old woman with no previous medical illness who presented with on-and-off abdominal pain, was found to have a left colonic mass, and underwent laparoscopic left hemicolectomy, with the final histopathological assessment revealing smooth muscle leiomyoma.

Colonic Leiomyoma: A Case Report of an Uncommon Endoscopic Finding

Leiomyomas are rare, benign tumors composed of smooth muscle cells. When found in the colon, they account for only about 3% of gastrointestinal leiomyomas. Typically asymptomatic, they are often incidentally discovered during endoscopic evaluations. This report describes the case of a 71-year-old female with abdominal pain and distension, whose colonoscopy revealed a 7 mm sessile polyp in the sigmoid colon. Histological analysis confirmed it to be a submucosal leiomyoma. Although endoscopic resection is a common therapeutic strategy, surgical treatment may be necessary for larger tumors or when malignancy is suspected. This case emphasizes the limitations of polyp classification through endoscopy alone and the important role histopathological analysis continues to play in this regard. Accurately diagnosing these lesions is crucial for appropriate treatment and surveillance, namely, in the primary healthcare context. Further research is needed to improve diagnostic capabilities and reduce the need for repeat colonoscopies, reducing patient burden.

An Asymptomatic Patient with Colonic Leiomyoma

Subepithelial lesions (SELs) originating from muscularis mucosae of the colon are very rare findings on endoscopy. Appropriate management of SELs involves making a correct diagnosis and estimating their malignant potential. In this case study, a 58-year-old Saudi man presented with a small, 8-mm sigmoid polyp during screening colonoscopy. The polyp was removed by hot snare polypectomy and sent to pathology laboratory. Report showed an unremarkable colonic mucosa and underlying well-circumscribed submucosal lesion composed of monotonous spindle cells. Immunohistochemical (IHC) analysis ruled out CD117-/DOG1-positive GIST and confirmed the lesion as leiomyomatous polyp. Colonic leiomyomas are usually benign and often asymptomatic and discovered during CRC screening procedures. Diagnosis is made on histology/IHC analysis since endoscopically they might be indistinguishable from other SELs. Conventional polypectomy is an appropriate treatment for small colonic leiomyoma and these benign lesions typically do not recur.

Colonic leiomyoma mimicking a liver tumor: an unusual diagnosis after en-block robotic resection

Colonic leiomyomas are rare. Their clinical presentation ranges from asymptomatic polyps detected on endoscopy to large symptomatic abdominopelvic masses. Imaging findings are usually non-specific, and percutaneous biopsy might help with differential diagnosis. However, radical surgery with negative margins is ultimately needed to rule out malignancy. We describe an uncommon presentation of a colonic leiomyoma mimicking a right hepatic lobe tumor on preoperative imaging. The robotic approach allowed a precise abdominal exploration with confirmation of colonic and hepatic infiltration and subsequent oncological en-block resection. Surgeons operating on hepatic tumors close to the right colic flexure should be aware of this diagnosis.

Leiomyoma in the Transverse Colon With Resection

Benign proliferations of smooth muscle cells are known as leiomyomas; these proliferations can occur in the colon and are typically found incidentally. Colonic leiomyomas are very rare and are most commonly found in the descending or sigmoid colon. A 59-year-old Hispanic female presented to the gastroenterology clinic for surveillance colonoscopy. The biopsy showed a submucosal microscopic leiomyoma in the transverse colon. The treatment of choice for most colonic leiomyomas is surgical excision. This rare case favors the notion that endoscopic polypectomy may be superior to surgical excision, ultimately providing a less-invasive and less-costly procedure without complications or recurrence.

Sigmoid Leiomyoma: An Uncommon Occurrence

Leiomyomas in the colon are uncommon accounting for a few cases of gastrointestinal smooth muscle tumors. These tumors are usually benign and asymptomatic. They may present with abdominal pain, intestinal obstruction, perforation, and rarely hemorrhagic, especially when the tumor is large. We present the case of a sigmoid leiomyoma in a 60-year-old patient consulting for a positive fecal occult blood test. Colonic leiomyomas should be considered in the differential diagnosis when a polyp is found during routine endoscopic evaluations. This case also highlights the limitations of diagnosing the nature of polyps using endoscopy alone.

Total laparoscopic surgery for treatment of leiomyoma of the transverse colon in a patient with an abdominal mesh: A case report

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Leiomyomas of the colon are rare and account for 3% of gastrointestinal leiomyomas.

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The patient had an abdominal mesh from a prior surgery.

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Laparoscopic colectomy was used for treatment of leiomyoma of the transverse colon.

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Laparoscopic colectomy prevented damage to the abdominal mesh.

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Total laparoscopic surgery is a viable option in patients with abdominal mesh.

Introduction

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract; however, gastrointestinal leiomyomas are relatively rare. Surgical resection is recommended for leiomyomas and gastrointestinal stromal tumors of the colon. We present a case in which we performed laparoscopic right hemicolectomy with intraabdominal anastomosis for treating leiomyoma of the transverse colon in a patient with an abdominal mesh.

Presentation of case

A 64-year-old woman with a history of right subtotal adrenalectomy and right mastectomy was incidentally found to have an abdominal mass on a follow-up computed tomography (CT) scan, which was confirmed as a gastrointestinal stromal tumor of the mesentery following abdominal contrast-enhanced CT. We planned surgical resection for preoperative diagnosis because the tumor was >5 cm in diameter. However, she had undergone transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after right mastectomy, in which the TRAM flap was replaced with an abdominal mesh; hence, total laparoscopic surgery was performed to avoid damaging the mesh owing to the risk of mesh infection. Laparotomy revealed that the tumor originated from the transverse colon; thus, transverse colectomy with intraabdominal anastomosis was performed. The total operative time and blood loss were 3 h 32 min and 5 mL, respectively. No postoperative leakage or mesh infection was observed. The resected specimen revealed a leiomyoma without malignancy.

Discussion

We successfully performed colectomy that minimized the resection range and intraabdominal anastomosis.

Conclusion

Total laparoscopic surgery was effective for colonic leiomyoma with an abdominal mesh to avoid mesh-related complications.

Two Cases of Leiomyoma in the Colon Masquerading as Other Types of Colonic Pedunculated Polyps

We describe two cases of leiomyoma in the colon that were diagnosed histologically after endoscopic resection. The first case was a 79-year-old Japanese woman who presented with a pedunculated polyp of 14 mm length at the splenic flexure. Preoperative diagnosis suggested a colonic mucosubmucosal elongated polyp. The second case was a 29-year-old Japanese woman who presented with a pedunculated polyp of 40 mm length at the hepatic flexure and had an ulcer on top of the polyp. Preoperative diagnosis suggested an inflammatory fibroid polyp. A pathological diagnosis of colonic leiomyoma was made after endoscopic resection in both cases. Both tumors were confirmed to originate, not from the proper muscle layer, but from the muscularis mucosae. These cases underscore that although colonic involvement is infrequent, leiomyomas can display pedunculated morphology in the colon rather than the typical gross appearance of gastrointestinal submucosal tumors seen with sessile morphology.