The Diagnostic Value of Endoprobe for Small Esophageal Leiomyomas Derived from the Muscularis Mucosae

Abstract

Esophageal leiomyoma derived from the muscularis mucosae (MM) is a rare condition, and the optimal modality for diagnosis and treatment is controversial. Endoscopic ultrasonography can provide an accurate image of esophageal layer structure, providing information on lesion suitability for potential endoscopic therapy. We attempted to investigate the diagnostic value of a transendoscopic balloon-tipped miniature ultrasonic endoprobe for small esophageal leiomyomas derived from MM. We resected 7 small esophageal leiomyomas derived from MM by endoscopic mucosal resection (EMR), all of which were diagnosed by a balloon-tipped endoprobe. The endosonographic and pathologic features of 7 cases of small esophageal leiomyomas derived from MM were compared. The balloon-tipped endoprobe clearly showed all 7 small esophageal leiomyomas derived from MM, even those under 5 mm in size (smallest lesion, 3.0 mm). The endosonographic characteristics of small esophageal leiomyomas derived from MM were a hypoechoic mass with smooth, regular, and a well-defined outer margin and homogenous inner echogram arising from the second hypoechoic layer. Complete resections were possible in all 7 cases by EMR without any complications. Tumor size was 3.0 - 13.5 mm (mean 7.8 mm) in maximum diameter. In all cases, endosonographic findings by endoprobe were exactly concordant with pathologic finding in determining the tumors depth in the esophageal wall, tissue origin and characteristics, growth pattern, and size. We detail the balloon-tipped endoprobe is a simple, convenient, and very useful in making accurate diagnosis of small esophageal leiomyomas derived from the MM and the appropriate applications of EMR.

Lymph node characteristics of sarcoidosis with endobronchial ultrasound

“…Lesions of the gastrointestinal system visualized with EUS, have showed that a heterogeneous echogenicity was more likely to indicate a malignancy than homogeneous echogenicity. [ 27 28 29 30 ] In the present study homogeneous echogenicity was associated with the diagnosis of sarcoidosis. Furthermore, presence of granules in a lymph node visualized by EBUS standard for the diagnosis of sarcoidosis with high positive predictive value.…”

Predicting the Risk of Malignancy of Lung Nodules Diagnosed as Indeterminate on Radial Endobronchial Ultrasound-Guided Biopsy

“…Echogenicity on radial EBUS images is closely associated with the arrangement of cells and the quantity of fibrous stroma [ 7 ]. Several studies [ 15 , 16 , 17 , 18 ] on gastrointestinal tract lesions have revealed that heterogeneous echogenicity is more likely to indicate malignancy than homogeneous echogenicity. It is believed that loss of normal tissue and chaotic tumor cell growth with central fibrosis, necrosis, and hemorrhage leads to heterogeneity in the internal structure of lung masses on EBUS images [ 8 ].…”

Laparoscopic approach in the treatment of large leiomyoma of the lower third of the esophagus.

“…Esophageal leiomyoma usually affects patients between 20 and 50 years of age, with a male to female ratio of 2 : 1 and a propensity to develop in the lower two-thirds of the esophagus [ 2 , 4 ]. Esophageal leiomyoma derives from the muscularis mucosae or muscularis propria layer of the esophagus, and represents hyperproliferation of interlacing bundles of smooth muscle cells that are well demarcated by adjacent tissue or by a smooth connective tissue capsule [ 19 , 20 ]. The size of the lesion may not change for many years.…”