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Kumari S, Saeed MI, Ismail FW, Ibrahim MB. Esophageal leiomyoma within an epinephric diverticulum. Radiol Case Rep 2024; 19:2472-2476. [PMID: 38577127 PMCID: PMC10992280 DOI: 10.1016/j.radcr.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Epinephric diverticula are distal esophageal pouches protruding from the epithelial lining of the esophagus while esophageal leiomyomas are benign smooth muscle lesions that constitute a significant percentage of all gastrointestinal leiomyomas. Epinephric diverticula and esophageal leiomyomas are common individually but their co-existence is rare. Moreover, they present asymptomatically but can occasionally present with complains of dysphagia and weight loss. In this paper, we present a 58-year-old Asian man with three months history of indigestion and progressive weight loss. Preoperatively, CT Scan with IV Contrast showed a large soft tissue mass appearing on the right distal esophageal wall, with its lumen communicating with the esophageal lumen, likely representing an epinephric diverticulum. Biopsy and immunohistochemistry stains confirmed the diagnosis of smooth muscle neoplasm, likely a leiomyoma. Later, the patient underwent a two-stage esophagectomy. The postoperative biopsy was consistent with the initial one: therefore, supporting the diagnosis of a leiomyoma. Postoperatively, the recovery remained uneventful.
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Affiliation(s)
- Sameeta Kumari
- Medical Graduate, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ibrahim Saeed
- Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Faisal Waseem Ismail
- Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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2
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Yang W, Zhang J, Wang C, Chen Y, Ma W, Wu W. Enucleation of Esophageal Leiomyoma Less Than 3 cm: Submucosal Tunneling Endoscopic Resection Versus Thoracoscopic Resection. J Gastrointest Surg 2022; 27:777-779. [PMID: 36422839 DOI: 10.1007/s11605-022-05518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/24/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Wei Yang
- Department of Gastroenterology, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Jinshun Zhang
- Health Management Center, Taizhou Hospital, Zhejiang Province, Linhai, China.
| | - Chunguo Wang
- Department of Thoracic Surgery, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Yahong Chen
- Health Management Center, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Weiwei Ma
- Endoscopic Center, Taizhou Hospital, Zhejiang Province, Linhai, China
| | - Weidan Wu
- Department of Gastroenterology, Taizhou Hospital, Zhejiang Province, Linhai, China
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3
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Gadelkarim M, Harpole B, Abdelsattar Z. Totally robotic enucleation of a mid- esophageal leiomyoma. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35224900 DOI: 10.1510/mmcts.2022.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Enucleation of an esophageal leiomyoma is the treatment of choice in symptomatic patients. Several open or minimally invasive approaches have been shown to be safe and effective. Robotic approaches allow for delicate and precise dissection with improved three-dimensional visualization. The robotic operative technique for enucleation has not been well described. In this context, we present the case of a 53-year-old obese man struggling with dysphagia and odynophagia due to a mid-esophageal leiomyoma. In the case presentation, we review the preoperative workup with high-quality images, robotic port placement, equipment needed, intraoperative conduct, and postoperative course. We provide a step-by-step video tutorial encompassing the preoperative workup, operative steps, tips and tricks, and postoperative course using a totally robotic enucleation of a 7-cm mid-esophageal leiomyoma. This case presentation can serve as a comprehensive teaching case for trainees and a high-quality example of the conduct of the operation for practicing surgeons, including some tips and tricks for optimal results. We also highlight that an assistant port is not required.
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Affiliation(s)
- Mohamed Gadelkarim
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Chicago IL
| | - Bethany Harpole
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Chicago IL
| | - Zaid Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Chicago IL
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4
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Wang TY, Wang BL, Wang FR, Jing MY, Zhang LD, Zhang DK. Thoracoscopic resection of a large lower esophageal schwannoma: A case report and review of the literature. World J Clin Cases 2021; 9:11061-11070. [PMID: 35047619 PMCID: PMC8678873 DOI: 10.12998/wjcc.v9.i35.11061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/28/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal schwannomas originating from Schwann cells are extremely rare esophageal tumors. They commonly occur in the upper and middle esophagus but less frequently in the lower esophagus. Herein, we report a rare case of a large lower esophageal schwannoma misdiagnosed as a leiomyoma. We also present a brief literature review on lower esophageal schwannomas.
CASE SUMMARY A 62-year-old man presented with severe dysphagia lasting 6 mo. A barium esophagogram showed that the lower esophagus was compressed within approximately 5.5 cm. Endoscopy revealed the presence of a large submucosal protuberant lesion in the esophagus at a distance of 32-38 cm from the incisors. Endoscopic ultrasound findings demonstrated a 4.5 cm × 5.0 cm hypoechoic lesion. Chest computed tomography revealed a mass of size approximately 53 mm × 39 mm × 50 mm. Initial tests revealed features indicative of leiomyoma. After multidisciplinary discussions, the patient underwent a video-assisted thoracoscopic partial esophagectomy. Further investigation involving immunohistochemical examination confirming palisading spindle cells as positive for S100 and Sox10 led to the final diagnosis of a lower esophageal schwannoma. There was no tumor recurrence or metastasis during follow-up.
CONCLUSION The final diagnosis of esophageal schwannoma requires histopathological and immunohistochemical examination. The early appropriate surgery favors a remarkable prognosis.
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Affiliation(s)
- Tian-Yi Wang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Bian-Li Wang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Fu-Rong Wang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Meng-Yuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Lu-Dan Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - De-Kui Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
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5
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Singla V, Gupta E, Bhattacharjee H, Joshi M, Sharma R, Parshad R. Thoracoscopic enucleation of a large esophageal leiomyoma in the lower esophagus: challenges and solutions. Indian J Thorac Cardiovasc Surg 2021; 37:694-697. [PMID: 34776669 DOI: 10.1007/s12055-021-01196-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022] Open
Abstract
Esophageal leiomyomas are rare tumors which have been conventionally managed using open surgery. Only few reports describe the enucleation of large or circumferential leiomyoma successfully managed by thoracoscopy. We herein describe a case of a large circumferential esophageal leiomyoma successfully enucleated using thoracoscopy. An asymptomatic 28-year-old gentleman was diagnosed with a posterior mediastinal mass on a screening chest radiograph. On further investigations with computerized tomography scan and endoscopy, he was diagnosed to have a circumferential homogenous 7×5 cm submucosal lesion in the lower end of the esophagus. Magnetic resonance imaging was performed to rule out duplication cyst and positron emission scan to rule out malignancy in view of suspicious features on endoscopic ultrasound. The final provisional diagnosis was benign lesion of the esophagus. Biopsy of tumor was avoided preoperatively to decrease the chances of intraoperative mucosal injury. The patient was planned for a thoracoscopic enucleation. The tumor was enucleated with meticulous dissection in the submucosal plane with use of stay sutures and minimal use of cautery. There was a pinpoint mucosal perforation which was repaired. The integrity of repair was checked using methylene blue insufflation test and endoscopy. The patient had an uneventful recovery with postoperative gastrografin showing no leak or stricture. Conclusively, a large esophageal leiomyoma may be safely enucleated thoracoscopically with meticulous dissection. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-021-01196-z.
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Affiliation(s)
- Vitish Singla
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Ekansh Gupta
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanga Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Joshi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Parshad
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Le DN, Nguyen VH, Duong TN, Than TV. Complete thoracoscopic enucleation of the esophageal leiomyoma at the level of the azygos vein: A case report. Int J Surg Case Rep 2021; 88:106537. [PMID: 34717274 PMCID: PMC8577447 DOI: 10.1016/j.ijscr.2021.106537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
Benign tumors of the esophagus are rare. Among them, leiomyomas are common. Surgical enucleation is indicated in cases, which have symptoms or large tumors. The enucleation through video assisted thoracoscopic surgery has been developed as a preferred approach for the majority of lesions in recent years. However, the complete thoracoscopic enucleation for an esophagus leiomyoma at the level of the azygos vein without cutting the vein and nor using artificial pneumothorax by CO2 insufflations is a challenge for thoracic surgeons. This case report was a 64-year-old female who presented dysphagia and chest pain. Chest computed tomography and esophageal endoscopy displayed an esophageal mass. We used complete thoracoscopic enucleation to treat this condition. The tumor was at the level of the azygos vein. Therefore, it was difficult to remove the tumor without cutting the azygos vein without utilizing the artificial pneumothorax. However, we enucleated it completely with no complications. The complete thoracoscopic enucleation of the esophageal leiomyoma at the level of the azygos vein without cutting the vein without using the artificial pneumothorax should be applied. A methylene blue swallowing study is an alternative method to a barrium swallowing study while the chest tube is still placed in the pleural space.
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Affiliation(s)
- Duc Nhan Le
- The Thoracic Surgery Department, Da Nang Hospital, Viet Nam
| | | | - Thi Nga Duong
- The Thoracic Surgery Department, Da Nang Hospital, Viet Nam
| | - Trong Vu Than
- The Thoracic Surgery Department, Da Nang Hospital, Viet Nam.
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7
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Kemuriyama K, Motoyama S, Sato Y, Wakita A, Nagaki Y, Fujita H, Sasamori R, Imai K, Aokawa M, Minamiya Y. Robot-assisted thoracoscopic enucleation for a large esophageal leiomyoma: a case report. Surg Case Rep 2021; 7:129. [PMID: 34037886 PMCID: PMC8155148 DOI: 10.1186/s40792-021-01212-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is being used to treat esophageal submucosal tumors (SMTs) all over the world. However, this technique is difficult when the tumor is large and located on the left side wall of the esophagus, within the upper mediastinum. This is because, with VATS, the surgical forceps have a limited range of motion. Robot-assisted thoracoscopic surgery (RATS) using the da Vinci surgical system may be extremely useful for enucleation of esophageal SMTs within the narrow upper mediastinum. Case presentation A female in her thirties experiencing epigastric pain visited our hospital and was diagnosed with a large esophageal leiomyoma within the upper mediastinum. From its size (10 cm), it was judged to have malignant potential. We performed SMT enucleation using RATS with a da Vinci surgical system Xi. This was our second case using this system. The patient was placed in the left lateral position. Four da Vinci trocars (8 mm) were inserted into the 10th, 7th, 5th and 3rd intercostal spaces (ICS), and an assist port was added in the 5th ICS. We opened the superior mediastinal pleura cranially and caudally from the arch of the azygos vein and expanded the superior mediastinum after dividing the azygos vein. We made an incision in the muscular layer of the esophagus and, using a monopolar hook and monopolar scissors, enucleated the esophageal tumor in a protective manner so as not to damage its capsule or mucosa while applying appropriate robot-specific counter traction. We then sewed up the muscularis using 4–0 Vicryl, inserting the endoscope into the thoracic esophagus to substitute for a bougie. In addition, the pleura was sutured using barbed suture. The surgical procedure was straightforward and smooth. The patient was discharged on postoperative day 4 with no surgical complications. The tumor was definitively diagnosed pathologically from paraffin sections as a benign esophageal leiomyoma. Conclusions RATS enables more delicate and precise esophageal SMT enucleation without surgical complications, though various challenges remain to be overcome. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-021-01212-9.
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Affiliation(s)
- Kohei Kemuriyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan. .,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan. .,Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yusuke Sato
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yushi Nagaki
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromu Fujita
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryohei Sasamori
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaki Aokawa
- Gastroenterology, Noshiro Kousei Medical Center, Noshiro, Japan
| | - Yoshihiro Minamiya
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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8
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Abstract
BACKGROUND Leiomyomas of the esophagus are rare tumors but the most common benign lesion of the esophagus originating from smooth muscle cells. The symptoms are mainly determined by the size of the tumor and are caused by dysphagia and/or retrosternal pain. The majority of patients are however asymptomatic. The diagnostics include esophagoscopy, endosonography and chest computed tomography. Surgery is considered the treatment of choice and ideally involves enucleation of the tumor but may lead to esophagectomy. In addition to the classical open procedures, minimally invasive procedures are also used. Regardless of the selected procedure, a lesion of the mucosa should be avoided. OBJECTIVE A review of the literature on thoracoscopic and robotic resections in the treatment of leiomyomas was carried out and an illustration of a clinical case is presented. MATERIAL AND METHODS A review of minimally invasive surgical treatment of esophageal leiomyomas is presented. The literature search was carried out in PubMed for publications of thoracoscopic and robotic-assisted thoracic enucleation of leiomyomas of the esophagus. In addition, the robotic-assisted thoracic enucleation of a horseshoe-shaped leiomyoma in the middle third of the esophagus is described. RESULTS The enucleation of the esophageal leiomyoma was carried out through a right-sided robotic-assisted operation with one lung ventilation. The surgery time was 143 min. There were no intraoperative or postoperative complications. On the 3rd postoperative day a light diet was started and the thorax drainage was removed. Histopathology confirmed a leiomyoma. The patient was discharged on the 5th postoperative day and free of complaints. CONCLUSION Robotic-assisted surgery for leiomyomas of the esophagus is a safe procedure. Taking the available data into account, robotic-assisted thoracic enucleation of leiomyomas was characterized by less mucosal lesions, general complications and a lower conversion rate as well as a shorter hospital stay compared to classical thoracoscopic enucleation. Thus, robotic-assisted surgery can be the method of choice for leiomyomas of the esophagus.
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Affiliation(s)
- S Inderhees
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland.
| | - J Tank
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - H J Stein
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - A Dubecz
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
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9
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Zhu S, Lin J, Huang S. Successful en bloc endoscopic full-thickness resection of a giant cervical esophageal leiomyoma originating from muscularis propria. J Cardiothorac Surg 2019; 14:16. [PMID: 30665433 PMCID: PMC6341741 DOI: 10.1186/s13019-019-0847-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal leiomyomas, the most common benign primary tumors of the esophagus, are esophageal subepithelial lesions treated by surgery traditionally. In recent years, endoscopic submucosal dissection and related endoscopic treatment techniques are adopted by endoscopists to resect gastrointestinal submucosal tumors. But if a giant esophageal leiomyoma approaches the esophagus entrance and originates from the deep layer of muscularis propria, it will be difficult for both endoscopic resection and surgical treatment. Especially, endoscopic resection has a high risk of huge perforation difficult to be sutured. CASE PRESENTATION A 72-year-old man with dysphagia underwent gastroscopy examination which indicated a large submucous eminence lesion, about 18-24 cm from the incisors. Endoscopic ultrasonography revealed the lesion was hypoechoic and originated from the muscularis propria with a clear boundary. The patient refused invasive surgical resection. Then, an en bloc endoscopic full-thickness resection was performed, which perforation was successfully closed with purse-string sutures using a novel endoloop device through standard single-channel endoscopy. Histopathologic examination showed an esophageal leiomyoma. CONCLUSION This endoscopic procedure may be an alternative to avoid surgery for the removal of a giant upper esophagus tumor from muscularis propria layer.
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Affiliation(s)
- Sumin Zhu
- Department of Gastroenterology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Lin
- Department of Gastroenterology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Shu Huang
- Department of Gastroenterology, People's Hospital of Lianshui, 6 Hongri Road, Huaian, China.
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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11
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Yu S, Chen S, Han Z, Chen S, Chen M, Lin J, Huang S, Gao L, Kang M. A useful method to keep azygos arch in minimally invasive resection of esophageal leiomyoma. J Thorac Dis 2017; 9:4589-4591. [PMID: 29268529 DOI: 10.21037/jtd.2017.09.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lifting azygos arch with a prolene line is a useful way to keep azygos arch in minimally invasive resection of esophageal leiomyoma without affecting surgical exposure and operative procedure.
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Affiliation(s)
- Shaobin Yu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shuchen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Ziyang Han
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Sui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingduan Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Jinghong Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shijie Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Lei Gao
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350122, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou 350122, China
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12
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Ishii M, Takeno S, Nishida T, Nanashima A, Kubota Y, Kawakami H, Umekita Y, Akiyama Y. Thoracoscopic enucleation in the left decubitus position for leiomyoma of the upper thoracic esophagus: Utility of preoperative diagnosis applying endoscopic ultrasound-guided fine needle aspiration. Int J Surg Case Rep 2017; 34:49-55. [PMID: 28371632 PMCID: PMC5377431 DOI: 10.1016/j.ijscr.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 12/21/2022] Open
Abstract
We report a case of esophageal leiomyoma enucleated by thoracoscopic procedures. Preoperative EUS-FNA is useful to decide the operative procedure. Preoperative EUS-FNA does not adversely influence subsequent enucleation. Precise preoperative diagnosis is necessary to avoid excessive surgery.
Introduction We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature. Presentaion of case A submucosal tumor 45 mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good. Discussion The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation. Conclusion Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
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Affiliation(s)
- Mitsutoshi Ishii
- Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki.
| | - Shinsuke Takeno
- Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital
| | - Takahiro Nishida
- Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital
| | - Atsushi Nanashima
- Division of Endoscopy, University of Miyazaki Hospital; Division of Hepato-biliary-pancreas Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki; Center for Digestive Disease, University of Miyazaki Hospital
| | - Hiroshi Kawakami
- Division of Endoscopy, University of Miyazaki Hospital; Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki; Center for Digestive Disease, University of Miyazaki Hospital
| | - Yoshiko Umekita
- Department of Clinical Laboratory, Faculty of Medicine, University of Miyazaki
| | - Yutaka Akiyama
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Kihara 5200, Kiyotake-cho, Miyazaki City, Miyazaki 889-1692, Japan
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13
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Abstract
A 53‐year‐old man presented with heart palpitations while swallowing. Electrophysiologic study (EPS) and immunohistochemical results of his esophageal leiomyoma suggested that swallowing‐induced atrial tachycardia is related with neural reflex. S100‐immunopositive nerve fibers are demonstrated sympathetic nerves which possibly explain the mechanism. Metoprolol tartrate tablets are effective in our patient.
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Affiliation(s)
- Ye Xu
- Department of Cardiology Shanghai Institute of Cardiovascular Disease Zhongshan Hospital Fudan University Shanghai China
| | - Kuan Cheng
- Department of Cardiology Shanghai Institute of Cardiovascular Disease Zhongshan Hospital Fudan University Shanghai China
| | - Wenqing Zhu
- Department of Cardiology Shanghai Institute of Cardiovascular Disease Zhongshan Hospital Fudan University Shanghai China
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14
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Tan Y, Lv L, Duan T, Zhou J, Peng D, Tang Y, Liu D. Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer. Surg Endosc 2015; 30:3121-7. [PMID: 26487221 DOI: 10.1007/s00464-015-4567-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Submucosal tunneling endoscopic resection (STER) has been proved to be safe and effective for removal of esophageal leiomyoma originating from the muscularis propria (MP) layer. However, there are still technical challenges for tumors ≥35 mm due to the limited space of the submucosal tunnel. The aim of the study was to estimate the safety and efficacy of STER for large esophageal leiomyoma originating from the MP layer as well as compare its efficacy with video-assisted thoracoscopic surgery (VATS), which is a standard procedure for treating esophageal leiomyoma. METHODS We retrospectively collected the clinical data of the patients with esophageal leiomyoma of 35-55 mm who underwent STER or VATS at our hospital between January 2010 and December 2014. Epidemiological data (gender, age), tumor location, tumor size, procedure-related parameters, complications, length of stay and cost were compared between STER and VATS. RESULTS A total of 31 patients were enrolled, and 18 patients underwent STER and the other 13 received VATS. There was no significant difference between the two groups in gender, age, tumor location, tumor size, complications and rate of en bloc resection (P > 0.05). However, patients in the STER groups had a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost (P < 0.05). No recurrence was noted in the STER and VATS groups during a mean follow-up of 10.9 and 30.8 months, respectively. CONCLUSIONS The treatment efficacy was comparable between the STER and VATS for esophageal leiomyoma of 35-55 mm. However, STER is superior to VATS in a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost.
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Affiliation(s)
- Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Tianying Duan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Junfeng Zhou
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Dongzi Peng
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Yao Tang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, NO. 139 RenMin Road, Changsha, 410011, Hunan, People's Republic of China.
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15
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Wang YX, Zhang J, Liu Y, Liu Y, Chu XY, Lu ZS, Wang ZB, Tong XY. Diagnosis and comprehensive treatment of esophageal leiomyoma: clinical analysis of 77 patients. Int J Clin Exp Med 2015; 8:17214-17220. [PMID: 26770314 PMCID: PMC4694214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/27/2015] [Indexed: 06/05/2023]
Abstract
To investigate the diagnosis and comprehensive treatment of esophageal leiomyoma. The clinical data of 77 cases of esophageal leiomyoma patients were analyzed between 2005 and 2013. Its diagnosis, treatment and prognosis were analyzed. 39 cases of patients were with eating choking feeling, 18 cases presented with chest pain and weight loss and 20 cases without any symptoms. Preoperative endoscopic ultrasonography of each patient was diagnosed as possibility of esophageal submucosal tumor. 3 All patients underwent tumor enucleation, in which tumor electrotomy under gastroscope were done for 2 cases, complete video-assisted thoracoscopic (CVATS) resection of tumor for 24 cases, thoracoscope assisted small incision tumor resection for 29 cases, conventional thoracic tumor resection for 22 cases. The comparison and the difference of complete video-assisted thoracoscopic surgery group and the thoracoscope assisted small incision group for the operation time, bleeding volume, drainage volume, extubation time, hospitalization time and fasting time were not statistically significant (P < 0.05). All the patients recovered well and postoperative pathology of each patient was esophageal leiomyoma. They were followed up for 6 months to 8 years, average for 4 years, not recurrence of esophageal leiomyoma. Endoscopic ultrasonography is the most accurate method in diagnosis of esophageal leiomyoma. Esophageal leiomyoma which less than 1.0 cm in diameter, regular shape, originated in the muscularis mucosa, endoscopic electrotomy can be used as the preferred; Surgical operation is the main treatment of esophageal leiomyoma, three kinds of operation way has its own corresponding clinical indications, according to the clinical characteristics of patients and operator' habits to choose the corresponding operation way, all can achieve good treatment effect.
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Affiliation(s)
- Yun-Xi Wang
- Department of Thoracic Surgery, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Jing Zhang
- Department of Thoracic Surgery, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Yi Liu
- Department of Thoracic Surgery, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Yang Liu
- Department of Thoracic Surgery, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Xiang-Yang Chu
- Department of Thoracic Surgery, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Zhong-Sheng Lu
- Department of Gastroenterology, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Zhan-Bo Wang
- Department of Pathology, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
| | - Xin-Yuan Tong
- Department of Medical Statistics, The General Hospital of The Chinese People’s Liberation ArmyBeijing 100853, China
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16
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Maki K, Takeno S, Nimura S, Yamana I, Shimaoka H, Hashimoto T, Shibata R, Shiwaku H, Yamashita K, Yamashita Y. Prone Position Is Useful in Thoracoscopic Enucleation of Esophageal Leiomyoma. Case Rep Gastroenterol 2015; 9:165-70. [PMID: 26120297 PMCID: PMC4478339 DOI: 10.1159/000382071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 36-year-old man was admitted to our institute due to the diagnosis of esophageal submucosal tumor detected by a periodical upper gastrointestinal endoscopic examination without any complaint. Thoracoscopic enucleation of the lesion with the preoperative clinical diagnosis of esophageal leiomyoma was performed under general anesthesia in the prone position. After immunohistochemical examination, the pathological diagnosis was leiomyoma. There was no remarkable event during the postoperative hospital stay, and the patient was discharged on the 12th day after surgery. This case report suggests that the prone position might be superior to the left lateral decubitus position in thoracoscopic enucleation of esophageal leiomyoma.
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Affiliation(s)
- Kenji Maki
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinsuke Takeno
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Nimura
- Departments of Pathology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ippei Yamana
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hideki Shimaoka
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tatsuya Hashimoto
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ryousuke Shibata
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hironari Shiwaku
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kanefumi Yamashita
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuichi Yamashita
- Departments of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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17
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Compean SD, Gaur P, Kim MP. Robot assisted thoracoscopic resection of giant esophageal leiomyoma. Int J Surg Case Rep 2014; 5:1132-4. [PMID: 25460487 PMCID: PMC4275859 DOI: 10.1016/j.ijscr.2014.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/02/2014] [Accepted: 11/02/2014] [Indexed: 01/08/2023] Open
Abstract
Esophageal leiomyoma is most common benign esophageal tumor. Robot assisted surgery allows for resection of giant esophageal leiomyoma using minimally invasive approach.
INTRODUCTION Esophageal leiomyoma represents the most common benign esophageal tumor. Robot-assisted thoracoscopic surgery has provided ability to remove it successfully using a minimally invasive approach. PRESENTATION OF CASE A 63-year old female with history of chronic chest pain presented with an esophageal mass on chest CT and endoscopic ultrasound. Robot-assisted surgery was performed using three robot arms, a camera and an assistant port. A 10 cm leiomyoma was enucleated and removed through a 2 cm myotomy. Completion endoscopy confirmed integrity of the esophagus. Patient's chest pain resolved postoperatively, and she was discharged on postoperative day 3. DISCUSSION Our case describes successful removal of the giant esophageal leiomyoma (10 cm) by robot assisted minimally invasive resection through a 2 cm myotomy. CONCLUSION Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal.
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Affiliation(s)
- Steven D Compean
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Puja Gaur
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Min P Kim
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA; Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX 77030, USA.
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18
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Coskun A, Unubol M, Yukselen O, Yukselen V, Aydin A, Şen S, Onder Karaoglu A. Esophageal Leiomyoma in Patients with Megaloblastic Anemia. Euroasian J Hepatogastroenterol 2014; 4:98-100. [PMID: 29699356 PMCID: PMC5913904 DOI: 10.5005/jp-journals-10018-1110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 12/01/2022] Open
Abstract
Esophageal leiomyoma is the most common benign intramural tumor of esophagus. Although its incidence is not exactly known, it is very rare (0.006%-0.1% in autopsy series). It is generally asymptomatic and detected incidentally. Here, we present a rare case report describing coexistence of megaloblastic anemia and esophageal leiomyoma. How to cite this article: Coskun A, Unubol M, Yukselen O, Yukselen V, Aydin A, Şen S, Karaoglu AO. Esophageal Leiomyoma in Patients with Megaloblastic Anemia. Euroasian J Hepato-Gastroenterol 2014;4(2):98-100.
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Affiliation(s)
- Adil Coskun
- Department of Gastroenterology, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Mustafa Unubol
- Department of Endocrinology, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Ozden Yukselen
- Department of Pathology, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Vahit Yukselen
- Department of Gastroenterology, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Ahmet Aydin
- Department of Gastroenterology, Ege University, School of Medicine, Izmir, Turkey
| | - Serdar Şen
- Department of Thoracic Surgery, Adnan Menderes University, School of Medicine, Aydin, Turkey
| | - Ali Onder Karaoglu
- Department of Gastroenterology, Adnan Menderes University, School of Medicine, Aydin, Turkey
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