Giant Esophageal Leiomyoma: Diagnostic and Therapeutic Challenges

Abstract

Patient: Male, 24-year-old Final Diagnosis: Giant esophageal leiomyoma Symptoms: Shortness of breath • productive cough • dysphagia Medication: — Clinical Procedure: — Specialty: Surgery Objective: Challenging differential diagnosis Background: Leiomyoma is a rare, benign, esophageal tumor that does not often measure >10 cm. Here, we report a case of giant esophageal leiomyoma in a 24-year-old man. Case Report: A 24-year-old man who smoked and had primary hypertension and glucose-6-phosphate dehydrogenase deficiency presented with a history of shortness of breath and productive cough with yellowish sputum, a long history of dysphagia to solid food, and a weight loss of 7 kg over 2 months. A chest X-ray revealed a mediastinum with a width >8 cm. Computed tomography of the patient’s chest revealed a multilobulated mass that originated from the upper and middle thoracic esophagus, caused severe narrowing of his esophageal lumen, and was compressing his trachea and right main bronchus. Resection of the tumor was performed and, because of the large defect after the surgery and the mucosal necrosis, the patient underwent an Ivor-Lewis esophagectomy. His postoperative course was uneventful. He had no symptoms when he was seen in the outpatient clinic for follow-up and fully recovered. Conclusions: Giant esophageal leiomyoma (GEL) is a rare oncological entity that presents several diagnostic and therapeutic challenges because of the scarcity of information in the medical literature on surgical management. The descriptions of techniques for surgical resection of GEL do not include ways to effectively perform subsequent reconstruction. The aim of the present paper was to contribute to this scant information by reporting our experience with performing an Ivor-Lewis esophagectomy to manage a case of GEL.

Primary malignant melanoma of the esophagus: differentiation from esophageal squamous cell carcinoma and leiomyoma using dynamic contrast-enhanced CT findings

“…Metastatic lymph nodes were not observed in esophageal leiomyoma. These results in our study were consistent with that of previous studies [ 8 , 25 ]. In addition, ΔAP-N CT value max of tumor was an independent factor for differentiating PMME from esophageal leiomyoma.…”

Minimally invasive techniques in the surgical approach of esophageal leiomyoma: a report case

“…The ratio of cases in men and women is approximately 2:1. 5,6 Although this pathology is twice as common in men, this report presents a case in female, who are in their 4 th decade of life, coinciding with the age range found in the literature.…”

A Large Esophageal Leiomyoma: Thoraco-Laparoscopic Enucleation or Esophagectomy and Reconstruction?

“…Submucosal tunneling endoscopic resection can also be indicated, but only for tumors with a diameter less than 3 cm and that are believed to be benign leiomyomas [ 9 ]. Esophagectomy is performed when the tumor is excessively complicated, has a horseshoe shape or circumference, or the tumor inextricably adheres to the esophageal mucosa [ 4 ]. However, esophagectomy with reconstruction takes many risks, including reflux, anastomotic stenosis, leakage that leads to mediastinal abscess, infection, and death, compared with enucleation.…”

“…Choosing treatment methods depends on the surgeon’s experience, the size and shape of the tumor, and the extent of adhesions between the tumor and the esophageal mucosa [ 3 ]. Indications for esophagectomy are given when the tumors are large, have a horseshoe shape or circumference, or the tumor is inextricably adhering to the esophageal mucosa [ 4 ]. The access route is generally determined by the location of the lesions and whether they are easily exposed.…”