Ewha Med J.  2023 Oct;46(4):e19. 10.12771/emj.2023.e19.

An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm

• Kim GH
• Joo DC
• Lee MW
• Lee BE
• Kim K

• KMID: 2547923
• DOI: http://doi.org/10.12771/emj.2023.e19

Abstract

Esophageal subepithelial tumors (SETs) are commonly encountered during screening endoscopy, and leiomyomas are the most common SET of the esophagus. Almost all patients with esophageal leiomyomas are asymptomatic; however, some present with dysphagia, depending on the size of the tumor and the extent to which it encroaches on the lumen. The typical endosonographic features of esophageal leiomyomas include well-demarcated, homogeneously hypoechoic lesions with echogenicity similar to that of the surrounding proper muscle layer, but without cystic changes. Histopathologically, esophageal leiomyomas do not undergo cystic or myxoid degeneration. This report presents a case involving a 65-year-old man with a symptomatic esophageal SET and endosonographic features indicative of malignant neoplasms, who was diagnosed with esophageal leiomyoma with cystic and myxoid degeneration following surgical resection.

Keyword

Endoscopic ultrasound; Esophagus; Leiomyoma; Mesenchymal tumors

Figure

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  Fig. 1. Endoscopic and endosonographic findings. (A) A subepithelial tumor, measuring 3 cm, without surface erosion or ulceration is evident in the lower esophagus. (B, C) Endoscopic ultrasonography reveals a heterogeneously hypoechoic lesion with cystic changes (arrow) in the proper muscle layer.

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  Fig. 2. Contrast-enhanced chest CT. (A, B) Asymmetric wall thickening with heterogeneous enhancement and a non-enhanced area (arrow) is evident in the lower esophagus.

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  Fig. 3. Histopathological findings. (A) Intersecting bundles or fascicles of bland spindle cells with eosinophilic cytoplasm are observed (hematoxylin and eosin stain, ×40). (B, C) Cystic (asterisk) and myxoid degeneration (arrow) is evident; however, significant cytological atypia, increased mitotic activity, and tumor necrosis are not detected (hematoxylin and eosin stain, ×40 and ×100, respectively). (D) Tumor cells are positive for smooth muscle actin stain (×400).

Reference

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