Differential clinical and pathological characteristics of esophageal stromal tumors and leiomyomata

Abstract

The objective of the study was to assess the differences in clinical and pathological characteristics between esophageal stromal tumor and leiomyoma. Data from 93 esophageal stromal tumors and leiomyomata cases were retrospectively analyzed, including clinical symptoms, endoscopic features, pathological characteristics, immunohistochemistry (IHC), and treatment. All cases underwent endoscopic ultrasonography examination before treatment. Lesions arising from the muscularis mucosa were resected by endoscopic mucosal resection or endoscopic submucosal dissection. Lesions arising from the muscularis propria were resected by surgery. All specimens were examined by IHC. Patients were followed up after endoscopic mucosal resection or endoscopic submucosal dissection. No difference was observed in clinical symptoms and endoscopic features between the two groups. Endoscopic ultrasonography demonstrated all lesions to be hypoechoic and well circumscribed. Most lesions >2 cm had heterogeneous internal ultrasound signal. In esophageal stromal tumor, 100% (29/29) were CD117-positive and DOG-1-positive; 72.4% (21/29) and 51.7% (15/29) were CD34-positive and smooth muscle actin-positive, respectively. In esophageal leiomyomata, 100% (64/64) were smooth muscle actin-positive and desmin-positive; 100% were CD117-negative and DOG-1-negative. No local recurrence was detected in followed up patients (n = 49) after an average of 1.8 years (1.0-3.0 years). IHC analyses are important for distinguishing esophageal stromal tumor from leiomyoma. Early endoscopic resection is an effective treatment option for esophageal stromal tumors >1 cm.

Telocytes in human oesophagus

“…However, the presence of TCs was recently documented within stroma of different segments of the gastrointestinal tract . Noteworthy, the oesophageal stroma is an active participant to several disorders . Moreover, it was previously suggested that TCs, by their ultrastructural features and paracrine secretory potential, might represent the origin of PEComa and GISTs in digestive tract.…”

Ligation-assisted endoscopic enucleation for treatment of esophageal subepithelial lesions originating from the muscularis propria: a preliminary study

“…In addition, esophageal submucosal tumors with smooth mucosa might always not be benign . Endoscopic and EUS finding cannot accurately distinguish between esophageal leiomyomas and GISTs . For these reasons, some patients who present with small SELs prefer resection.…”

“…31 Endoscopic and EUS finding cannot accurately distinguish between esophageal leiomyomas and GISTs. 32 For these reasons, some patients who present with small SELs prefer resection. Leiomyoma 6 None 2 Male 33 6 Middle Leiomyoma 13 None 3 Female 47 6 Lower Leiomyoma 15 None 4 Male 42 7 Lower Leiomyoma 9 None 5 Male 42 5 Middle Leiomyoma 17 None 6 Male 66 12 Lower GIST 16 Bleeding 7 Male 63 11 Middle Leiomyoma 15 None 8 Female 57 10 Middle Leiomyoma 8 None 9 Male 59 Recently, technical advances in EUS as well as new devices designed for endoscopic resection have opened up the field to many therapeutic possibilities.…”

Subepithelial Lesions

“…They usually appear as a solitary smooth flat or hemispheric bulge with intact overlying mucosa ( Fig. 28.7) [76]. Some may be annular and encircle the esophagus.…”