Diffuse muscular thickening of esophagus associated with multiple leiomyomas diagnosed by endoscopic ultrasonography

Diffuse esophageal leiomyomatosis with localized dense eosinophilic infiltration

“…First, in diagnosis, endoscopy and EUS scanning suggested a discrete lesion deep to the mucosa consistent with a leiomyoma, in contrast with the diffuse process suggested by CT. Though diffuse leiomyomatosis is usually characterized by the presence of numerous confluent nodules on EUS, 9 diffuse muscular thickening has been described in association with multiple esophageal leiomyomas 10 . The uncertainty regarding the pathology involved led to a thoracotomy to establish the definite diagnosis.…”

“…Though diffuse leiomyomatosis is usually characterized by the presence of numerous confluent nodules on EUS, 9 diffuse muscular thickening has been described in association with multiple esophageal leiomyomas. 10 The uncertainty regarding the pathology involved led to a thoracotomy to establish the definite diagnosis.…”

Multiple solitary leiomyomata of the esophagus *

“…8 Dierential diagnosis between multiple solitary leiomyomata and diuse leiomyomatosis is mandatory, because in the ®rst case the surgical treatment must be as conservative as possible, whereas in the second, if necessary, surgery means esophagectomy. 5 Sometimes diuse leiomyomatosis and multiple leiomyomata coexist, as in the case reported by Ikeda et al, 9 in which four independent tumors were found arising in the muscular layer of the esophagus, and a diuse thickening of the muscular layer in the distal esophagus was seen using endoscopic ultrasound. The case, however, is not supported by a histopathologic study.…”

“…Endoscopic ultrasound is now replacing traditional studies in the diagnosis of esophageal leiomyomata. Endoscopic ultrasound can precisely delimit the origin of the tumor in the muscular layer; although there are no defined criteria to distinguish sonographically between leiomyoma and leiomyosarcoma, the smaller size, the smooth borders and the homogeneity of the lesion suggest benignity 9 …”

“…Endoscopic ultrasound can precisely delimit the origin of the tumor in the muscular layer; although there are no de®ned criteria to distinguish sonographically between leiomyoma and leiomyosarcoma, the smaller size, the smooth borders and the homogeneity of the lesion suggest benignity. 9 There is some controversy in the treatment indications of esophageal leiomyoma, but most authors operate on all symptomatic tumors and tumors bigger than 5 cm in diameter. Enucleation of the tumor, open or thoracoscopically, is the preferred technique, as most lesions are intramural, eccentric and well encapsulated.…”