eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Leiomyoma

Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Coauthor(s): Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Brigham and Women's Hospital, Harvard University
Contributor Information and Disclosures

Updated: Feb 28, 2008

Introduction

Background

Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign esophageal tumors are leiomyomas; the others mostly are polyps and cysts. Thus, leiomyomas are the most common benign tumors of the esophagus.

Pathophysiology

Leiomyomas represent a hyperproliferation of interlacing bundles of smooth muscle cells that are well-demarcated by adjacent tissue or by a smooth connective tissue capsule. They usually arise as intramural growths, most commonly along the distal two thirds of the esophagus. They are multiple in approximately 5% of patients.

The majority of leiomyomas have been discovered incidentally during evaluation for dysphagia or during autopsy. Bleeding rarely occurs in cases of benign disease but typically is observed with leiomyosarcoma, the malignant counterpart of this tumor. The potential for malignant degeneration of leiomyomas is extremely small. In the distal esophagus, leiomyomas may reach large proportions and may encroach on the cardia of the stomach.

Frequency

International

Esophageal leiomyomas comprise less than 0.6% of all esophageal neoplasms, both in the United States and worldwide.

Race

No known differences

Sex

No known differences

Age

Typically occur in individuals aged 20-50 years

Clinical

History

  • Esophageal leiomyomas rarely cause symptoms when they are smaller than 5 cm in diameter.
  • Large tumors can cause dysphagia, vague retrosternal discomfort, chest pain, esophageal obstruction, and regurgitation.
  • Rarely, they can cause gastrointestinal bleeding, with erosion through the mucosa.

Physical

  • Other than the nonspecific symptoms associated with esophageal leiomyomas, very few physical findings are ever noted.
  • In extremely rare cases where severe esophageal obstruction is caused by a leiomyoma, weight loss and muscle wasting may be observed.

More on Esophageal Leiomyoma

Overview: Esophageal Leiomyoma
Differential Diagnoses & Workup: Esophageal Leiomyoma
Treatment & Medication: Esophageal Leiomyoma
Follow-up: Esophageal Leiomyoma
References
[ CLOSE WINDOW ]

References

  1. Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg. Sep 1995;181(3):257-62. [Medline].

  2. Boran C, Sengul N, Balaban YH, Gurel S. Multinodular leiomyoma of the esophagus with internodular hydropic degeneration and bulbous serosal protrusions similar to cotyledonoid uterine leiomyoma. Dis Esophagus. 2007;20(2):187-9. [Medline].

  3. Chiu PW, Lee YT, Ng EK. Resection of esophageal leiomyoma using an endoscopic submucosal dissection technique. Endoscopy. Nov 22 2006;[Medline].

  4. Elli E, Espat NJ, Berger R, Jacobsen G, Knoblock L, Horgan S. Robotic-assisted thoracoscopic resection of esophageal leiomyoma. Surg Endosc. Apr 2004;18(4):713-6. [Medline].

  5. Kent M, d'Amato T, Nordman C, Schuchert M, Landreneau R, Alvelo-Rivera M, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg. Jul 2007;134(1):176-81. [Medline].

  6. Knop S, Schupp M, Wardelmann E, Stueker D, Horger MS, Kanz L, et al. A new case of Carney triad: gastrointestinal stromal tumours and leiomyoma of the oesophagus do not show activating mutations of KIT and platelet-derived growth factor receptor alpha. J Clin Pathol. Oct 2006;59(10):1097-9. [Medline].

  7. Konstantakos AK, Douglas WI, Abdul-Karim FW, et al. Arteriovenous malformation of the esophagus disguised as a leiomyoma. Ann Thorac Surg. 1995;60:1798-1800. [Medline].

  8. Meirelles GS, Ravizzini G, Yeung HW, Akhurst T. Esophageal leiomyoma: a rare cause of false-positive FDG scans. Clin Nucl Med. Jun 2006;31(6):342-4. [Medline].

  9. Memisoglu E, Agarwal B, Akduman I, Prather C, Collins B, Civelek AC. Multimodality diagnostic imaging of diffuse esophageal leiomyomatosis. J Comput Assist Tomogr. Jan-Feb 2006;30(1):100-4. [Medline].

  10. Nemir P Jr, Wallace HW, Fallahnejad M. Diagnosis and surgical management of benign diseases of the esophagus. Curr Probl Surg. Mar 1976;13(3):1-74. [Medline].

  11. Palanivelu C, Rangarajan M, Senthilkumar R, Annapoorni S, Jategaonkar PA. Thoracoscopic management of benign tumors of the mid-esophagus: a retrospective study. Int J Surg. Oct 2007;5(5):328-31. [Medline].

  12. Postlethwait RW, Lowe JE. Benign tumors and cysts of the esophagus. In: Orringer MB, Zuidema GD, eds. Shackelford's Surgery of the Alimentary Tract. Vol 1. 4th ed. Philadelphia, Pa: WB Saunders; 1996:369-86.

  13. Prenzel KL, Schäfer E, Stippel D, Beckurts KT, Hölscher AH. Multiple giant leiomyomas of the esophagus and stomach. Dis Esophagus. 2006;19(6):504-8. [Medline].

  14. Priego P, Lobo E, Rodriguez G, Cabanas J, Perez de Oteyza J, Fresneda V. Endoscopic treatment of oesophageal leiomyoma: four new cases. Clin Transl Oncol. Feb 2007;9(2):106-9. [Medline].

  15. Punpale A, Rangole A, Bhambhani N, Karimundackal G, Desai N, de Souza A, et al. Leiomyoma of esophagus. Ann Thorac Cardiovasc Surg. Apr 2007;13(2):78-81. [Medline].

  16. Tio TL, Tytgat GN, eds. Atlas of Transintestinal Ultrasonography. Aalsmeer, The Netherlands: Smith Klein & French b.v; 1986.

  17. Wong NA, Pawade J. Mast cell-rich leiomyomas should not be mistaken for gastrointestinal stromal tumours. Histopathology. Aug 2007;51(2):273-5. [Medline].

  18. Yamada H, Morita T, Fujita M, Miyasaka Y, Senmaru N, Oshikiri T. Long-term results following thoracoscopic surgery for esophageal leiomyoma in four patients. Hepatogastroenterology. Sep 2007;54(78):1713-5. [Medline].

  19. Zaninotto G, Portale G, Costantini M, Rizzetto C, Salvador R, Rampado S, et al. Minimally invasive enucleation of esophageal leiomyoma. Surg Endosc. Sep 6 2006;[Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

benign tumors of the esophagus, esophageal neoplasms, benign esophageal tumors, leiomyomas, esophageal polyps, esophageal cysts, dysphagia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Anastasios K Konstantakos, MD, Clinical Associate Surgeon, Brigham and Women's Hospital, Harvard University
Disclosure: Nothing to disclose.

Medical Editor

Maurice A Cerulli, MD, FACG, Chief, Division of Gastroenterology and Hepatology, Associate Professor of Clinical Medicine, Department of Internal Medicine, Division of Gastroenterology, New York Methodist Hospital, Cornell University
Maurice A Cerulli, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.