Imaging Studies
Esophageal leiomyoma can be visualized using barium swallow. The classic appearance is a smooth concave mass underlying intact mucosa. Distinct sharp angles are seen at the junction of the tumor and normal tissue. Encroachment onto the esophageal lumen usually is observed.
Esophageal ultrasonography can be helpful in demonstrating a smooth, typically round, mass located in the muscularis without encroachment into the overlying mucosa or underlying adventitia.
Esophagoscopy may reveal a nonspecific tumor in the wall of the esophagus, typically without mucosal involvement (ulceration or erosion).
Procedures
Upon endoscopy, the lesions are identified as mobile submucosal masses.
Esophagoscopy should be performed to rule out carcinoma. It is important to remember that if a leiomyoma is suspected at esophagoscopy, a biopsy should not be performed if it would cause scarring at the biopsy site, which would hamper definitive extramucosal resection at surgery. A brush cytology may be performed. A leiomyoma (especially an ulcerated one) routinely is biopsied through the endoscope without any problems occurring in the ability to resect at a later date. In fact, an ulcer in a leiomyoma may be considered much worse than a mucosal biopsy.
Esophageal ultrasonography has aided in the diagnosis of leiomyomas, which demonstrate a homogeneous region of hypoechogenicity juxtaposed with the overlying mucosa.
Endoscopic ultrasonography is a useful technique for diagnosing and reaching treatment decisions for esophageal leiomyoma. [8]
Histologic Findings
Histologically, the tumors are comprised of bundles of interlacing smooth muscle cells, well-demarcated by adjacent tissue or by a definitive connective tissue capsule. They are composed of fascicles of spindle cells that tend to intersect with each other at varying angles. The tumor cells have blunt-ended elongated nuclei and show minimal atypia with few mitotic figures.
