Yonsei Med J.  2005 Feb;46(1):61-65. 10.3349/ymj.2005.46.1.61.

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

• Lee SJ
• Paik YH
• Lee DK
• Lee KS
• Lee SI

• KMID: 2158113
• DOI: http://doi.org/10.3349/ymj.2005.46.1.61

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.

Keyword

Endoscopic ultrasonography; leiomyoma; esophagus

MeSH Terms

Adult
*Endosonography
Esophageal Neoplasms/pathology/*ultrasonography
Esophagoscopy/*methods
Female
Humans
Leiomyoma/pathology/*ultrasonography
Male
Middle Aged
Mucous Membrane/pathology

Figure

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  Fig. 1 Endoscopic finding of case No. 4 demonstrates a submucosal tumor with intact overlying mucosa.

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  Fig. 2 High frequency ultrasonic endosonographic finding of case No. 4 shows a clear homogenous hypoechoic mass derived from the second layer of the esophagus (M, mass; MM, lamina muscularis mucosae; SM, submucosa; PM, proper muscle).

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  Fig. 3 Microscopic finding of resected specimens demonstrates the leiomyoma derived from the muscularis mucosae of the esophagus. Uniform, interlacing bundles of spindle-like cells without any mitotic bodies are seen (H&E stain, × 40).

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