Treatment of rectal leiomyoma by endoscopic resection

Abstract

Leiomyomas of the rectum are rare, with low reported incidence in literature. In most cases, patients are asymptomatic, and are often incidental endoscopic findings. The difficult distinction from leiomyosarcomas, associated with the possibility of recurrence, implies the absence of a standard treatment. Endoscopic resection, if well indicated, may be a therapeutic option. In this study, we report two cases of asymptomatic leiomyoma of the rectum in two patients, discovered incidentally during a routine colonoscopy, removed by conventional polypectomy and discuss its diagnostic and therapeutic aspects based on a literature review.<br>Os leiomiomas de reto são raros, com baixa incidência relatada na literatura; na maioria dos casos os pacientes são assintomáticos, sendo que em muitos casos são achados incidentais endoscópicos. A dificuldade de distinguí-los dos leiomiossarcomas, aliada a possibilidade de recorrência, implica na inexistência de um tratamento padrão. A ressecção endoscópica desde que bem indicada pode ser uma opção terapêutica. Reportamos dois casos de leiomioma de reto assintomáticos em dois pacientes, descobertos casualmente durante exame colonoscópico de rotina, removidos por polipectomia convencional e discutimos seus aspectos diagnósticos e terapêuticos, através de uma revisão da literatura

Rectal Leiomyoma, a Rare Entity

“…Overall, leiomyomas comprise about 0.03 to 0.05% of all rectal tumors. 6 While they are more common in women, there is data showing that leiomyomas of the gastrointestinal tract are more prevalent in males. A study done in 2001 evaluated a total of 88 patients in two institutions with confirmed leiomyoma of the rectum or colon.…”

“…Diagnostic modalities include colonoscopy, endoscopic ultrasound (EUS), computed tomography and magnetic resonance of the rectum. 6 After screening with colonoscopy, EUS is uniformly preferred over the aforementioned modalities. A cohort of 80 patients diagnosed with rectal cancer, showed that EUS was more accurate than CT in staging rectal carcinomas.…”

Spindle cell proliferations of the sigmoid colon, rectum and anus: a review with emphasis on perineurioma

“…Most leiomyomas are incidental findings in cancer or polyp surveillance programmes and, like perineurioma, are less than 10 mm in size . They can be seen endoscopically as both intramural and sessile or pedunculated intraluminal masses . Clinical manifestations include rectal bleeding, pain, obstruction and even perforation into the peritoneal cavity .…”

Colon Leiomyoma Diagnosed and Treated with Endoscopy

“…The peak incidence occurs in the third decade of life with a slight female predominance[2]. Colonic leiomyomas are usually asymptomatic and are detected incidentally during screening colonoscopy[5][6][7][8].…”