Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography-fine needle aspiration: A case report

Abstract

Background: Benign esophageal tumors are rare accounting for < 1% of esophageal tumors; two-thirds of which are leiomyomas. Esophageal leiomyoma is a benign tumor derived from mesenchymal tissue that is completely muscularly differentiated. Most esophageal leiomyomas are < 5 cm. Esophageal leiomyomas > 5 cm are rare. We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.

Case summary: A 35-year-old woman presented to the doctor because of a choking sensation after eating. Physical examination showed no positive signs. Gastroscopy indicated an uplifted change in the cardia. Enhanced computed tomography revealed space-occupying lesions in the lower part of the esophagus and cardia, which were likely to be malignant. Positron emission tomography-computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia. Malignant lesions were considered, and mesenchymal tumors were not excluded. Endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus, which was unclear from the esophageal wall. Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors. Finally, histological specimens obtained by endoscopic ultrasonography- fine needle aspiration suggested leiomyoma. The patient underwent laparoscopic local resection of the tumor. The postoperative pathological diagnosis was leiomyoma.

Conclusion: Endoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas. It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.

Keywords: Case report; Endoscopic ultrasonography; Endoscopic ultrasonography-fine needle aspiration; Esophageal tumor; Fine needle aspiration; Leiomyoma.

Figure 1

Stomach computed tomography images. A: Plain scan; B: Arterial phase; C: Venous phase.

Figure 2

Positron emission tomography–computed tomography image.

Figure 3

Endoscopic ultrasound examined the lower part of the esophagus near the cardia, and a hypoechoic mass was seen close to the esophageal wall growing outward. A: Large uplift of the cardia under endoscopy; B: Endoscopic ultrasonography image.

Figure 4

Pathological examination. A: Tissue specimen aspirated by endoscopic ultrasonography–fine needle aspiration (FNA); B: Cytological examination of FNA biopsy of tumor (hematoxylin and eosin staining, 400 ×); C: Immunohistochemical staining of FNA biopsy of tumor.

Figure 5

Laparoscopic local resection of the mass was performed and pathological examination. A: Postoperative whole tumor tissue specimen; B: Cytological examination of the whole tumor (hematoxylin and eosin staining, 400 ×); C: Immunohistochemical staining of the tumor.