Nine years experience in surgical approach of leiomyomatosis of esophagus

Abstract

BackgroundLeiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period.MethodsEpidemiological data (sex, age), the presenting symptoms, diagnostic examinations, tumor location, histopathological findings and the safety and efficacy of surgical resection are analyzed and assessed.Results5 men and 2 women with mean age of 56.9 years were operated. In 3 cases the tumor was located at the lower esophagus, while in the other 4 cases, the leiomyoma was found at the median third of esophagus. 4 patients had severe symptoms related to the leiomyoma, such as dysphagia and epigastric pain. All patients underwent a right postolateral thoracotomy with enucleation of the lesion. None of them received resection of part of the esophagus. The mean diameter of the resected tumors was 4.3 cm. The dimensions of leiomyomas were immediately associated with the symptoms. In no case was detected malignancy or recurrence. All patients were relieved from their symptoms, while postoperative morbidity and mortality did not occur.ConclusionsEsophageal leiomyoma is a benign tumor, which causes symptoms only if its size becomes large. Surgical enucleation is considered to be safe and effective, without complications.

Esophageal Leiomyoma with Esophagogastric Junction Outflow Obstruction at High Resolution Manometry

“…Esophagogastroscopy combined with endoscopic ultrasonographic evaluation of the tumor is mandatory in order to exclude cancer of esophagus from the differential diagnosis. Leiomyoma's typical appearance is of homogeneous and hypoechoic lesion with clear margin [13] which can easily be differentiated from a lipoma, cyst, or hemangioma in the esophageal wall. In our patient, highresolution manometry demonstrated an esophago-gastric junction outflow obstruction pattern according to Chicago classification and the mechanism for this pattern is unclear.…”

The results of surgical treatment of distal esophageal leiomyomatosis performed distal esophagectomy

“…Differential diagnoses include foreign oppressed disease of esophagus, malignant esophageal tumors such as squamous or adenomatous carcinomas or leiomyosarcoma and other benign tumors. There are controversies about the need of preoperative biopsy for diagnosis 13,14 . In cases of ulcerated mucosa and suspicion of cancer, endoscopic biopsy is prescribed 17 .…”

“…Approximately one-half of all tumors are smaller than 5 cm, but 5% may be larger than 10 cm 7 . Dysphagia with concomitant epigastric pain or retrosternal burning usually appears when the tumor's diameter becomes larger than the critical point of 4.5-5 cm 13 . In contrary to gastric leiomyomas, the bleeding of esophageal leiomyomas is rare because they do not ulcerate 14 .…”

Leiomioma esofágico: resección por videotoracoscopia. A propósito de un caso

“…Por otra parte, en muchos casos, la aspiración con aguja fina no permite proporcionar suficiente material para establecer un diagnóstico histopatológico preciso. El alto riesgo de complicaciones en combinación con el beneficio para el paciente hace que no sea recomendable llevar a cabo este procedimiento de diagnóstico 7 . En nuestro centro, se efectúa tratamiento quirúrgico por videotoracoscopia.…”