Korean J Gastroenterol.  2016 Oct;68(4):179-185. 10.4166/kjg.2016.68.4.179.

Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

• Choi HH
• Cho YS
• Choi SK
• Kim HK
• Kim SS
• Chae HS
• Shin OR

• KMID: 2383513
• DOI: http://doi.org/10.4166/kjg.2016.68.4.179

Abstract

BACKGROUND/AIMS
Although polypoid leiomyomas in the colon and rectum are rare, they are increasingly detected during colonoscopy. The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic removal for colorectal polypoid leiomyoma.
METHODS
Data were retrospectively collected from 22 patients with polypoid leiomyoma arising from the muscularis mucosae in the colon and rectum who underwent endoscopic removal at single referral gastrointestinal endoscopy unit. Colonoscopic findings, endoscopic removal, success rates, complication rates (bleeding or perforation), pathologic characteristics, and recurrence rates were investigated.
RESULTS
Most polypoid leiomyomas were small asymptomatic lesions less than 1 cm. The tumors were located predominantly in the left colon. Ten leiomyomas were removed using cold biopsy forceps, and 12 were resected by conventional polypectomy or endoscopic mucosal resection. All tumors arose from or involved the muscularis mucosa. There were no complications, such as bleeding or perforation. No local remnant lesions were found in 19 patients who underwent at least one follow-up colonoscopy.
CONCLUSIONS
This case series represent cases of small colorectal polypoid leiomyoma that were safely removed endoscopically. An awareness of their endoscopic and clinic-pathological characteristics may provide safe treatment strategy for colonic leiomyomatous tumors of similar size in capable hands.

Keyword

Colorectal neoplasms; Colonic polyps; Leiomyoma; Colonoscopy

MeSH Terms

Biopsy
Colon
Colonic Polyps
Colonoscopy
Colorectal Neoplasms
Endoscopy, Gastrointestinal
Follow-Up Studies
Hand
Hemorrhage
Humans
Leiomyoma*
Mucous Membrane
Rectum
Recurrence
Referral and Consultation
Retrospective Studies
Surgical Instruments

Figure

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  Fig. 1. Colonoscopic findings of polypoid leiomyomas. A typical leiomyoma (approximately 5-mm) presenting as smooth round sessile polyp (A), a 13-mm leiomyoma presenting as pedunculated polyp (B), and a 7-mm leiomyoma resembling a hyperplastic polyp (C).

• 

  Fig. 2. A 12-mm pedunculated leiomyoma removed by endoscopic mucosal resection.

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  Fig. 3. Histologic findings (H&E) showing well-circumscribed nodule arising from the muscularis mucosae (A, ×40) composed of well-differentiated smooth muscle cells (B, ×100). On immunohistochemistry, the tumor is positive for smooth muscle actin (C, ×100) and desmin (D, ×100).

Reference

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