Korean J Radiol.  2001 Sep;2(3):132-137. 10.3348/kjr.2001.2.3.132.

Esophageal Leiomyoma: Radiologic Findings in 12 Patients

Affiliations
  • 1Department of Radiology Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kslee@smc.samsung.co.kr

Abstract


OBJECTIVE
The aim of our study was to describe and compare the radiologic findings of esophageal leiomyomas. MATERIALS AND METHODS: The chest radiographic (n = 12), esophagographic (n = 12), CT (n = 12), and MR (n = 1) findings of surgically proven esophageal leiomyomas in 12 consecutive patients [ten men and two women aged 34 - 47 (mean, 39) years] were retrospectively reviewed. RESULTS: The tumors, surgical specimens of which ranged from 9 to 90 mm in diameter, were located in the upper (n = 1), middle (n = 5), or lower esophagus (n = 6). In ten of the 12 patients, chest radiography revealed the tumors as mediastinal masses. Esophagography showed them as eccentric, smoothly elevated filling defects in 11 patients and a multilobulated encircling filling defect in one. In 11 of the 12 patients, enhanced CT scans revealed a smooth (n = 9) or lobulated (n = 2) tumor margin, and attenuation was homogeneously low (n = 7) or iso (n = 4). In one patient, the tumor signal seen on T2-weighted MR images was slightly high. CONCLUSION: Esophageal leiomyomas, located mainly in the middle or distal esophagus, are consistently shown by esophagography to be mainly eccentrically elevated filling defects and at CT, lesions showing homogeneous low or isoattenuation are demonstrated.

Keyword

Esophagus, abnormalities; Esophagus, CT; Esophagus, MR; Esophagus, neoplasms

MeSH Terms

Adult
Comparative Study
Esophageal Neoplasms/*diagnosis/radiography
Esophagus/pathology
Female
Human
Leiomyoma/*diagnosis/radiography
Magnetic Resonance Imaging
Male
Middle Age
Tomography, X-Ray Computed

Figure

  • Fig. 1 Esophageal leiomyoma in a 35-year-old man who had suffered substernal pain for two months.A. Chest radiography reveals a right retrocardiac soft-tissue mass (arrows), with obliteration of the azygoesophageal recess interface.B. Esophagography indicates the presence of a large, smoothly elevated filling defect in the distal esophagus. Also note the extraluminal component of the mass (arrows).C. Enhanced CT scan (10-mm collimation) obtained at the ventricular level shows a homogeneous, iso-attenuated, pear-shaped mass, 75×45 mm in diameter, in the right azygoesophageal recess. Note the presence of gastrograffin-filled esophageal lumen (arrow).D. Enhanced coronal T1-weighted MR image reveals a slightly hyperintense lesion in the azygoesophageal recess area.E. T2-weighted MR image obtained at a level similar to that in C reveals a lesion slightly more hyperintense than chest wall muscle.

  • Fig. 2 Esophageal leiomyoma in a 34-year-old man who for one month had complained of abdominal fullness.A. Esophagography demonstrates a crescentic filling defect in the distal esophagus due to the presence of a smoothly elevated mass lesion. Also note the extraluminal component of the mass (arrows).B, C. Enhanced (10-mm collimation) CT scans obtained at the level of the liver dome reveal a circumferential, homogeneous, iso-attenuated mass measuring 60×45 mm in the distal esophagus.

  • Fig. 3 Esophageal leiomyoma in a 37-year-old man with mild dysphagia.A. Esophagography shows a soft tissue mass (arrows) surrounding the opacified esophageal lumen. Note that there is mild passage disturbance and mucosal rigidity in the distal esophagus.B. Unenhanced (10-mm collimation) CT scan obtained at another hospital at the level of the liver dome reveals a soft tissue mass measuring 80×40 mm (arrows) surrounding the gas-filled esophageal lumen.

  • Fig. 4 Esophageal leiomyoma in a 47-year-old man with no subjective symptoms.A. Thin-section (1-mm collimation) CT scan obtained at the level of the azygos arch shows a homogeneously iso-attenuated lesion (arrows) measuring 26×13 mm (arrows) between the azygos arch and the esophageal lumen, posterior to the carina.B. Enhanced CT scan (7-mm collimation) demonstrates slight homogeneous enhancement.


Reference

1. Seremetis MG, Lyons WS, Deguzman VC, Peabody JW. Leiomyomata of the esophagus. Cancer. 1976; 38:2166–2175. PMID: 991129.
2. Moersch HJ, Harrington SW. Benign tumor of the esophagus. Ann Otol. 1944; 53:800–817.
3. Barreiro F, Seco JL, Molina J, et al. Giant esophageal leiomyoma with secondary megaesophagus. Surgery. 1976; 79:436–439. PMID: 1257906.
4. Gallinger S, Steinhardt MI, Goldger M. Giant leiomyoma of the esophagus. Am J Gastroenterol. 1983; 78:708–711. PMID: 6637958.
5. Montesi A, Pesaresi A, Graziani L, Salmistraro D, Dini L, Bearzi I. Small benign tumors of the esophagus: radiological diagnosis with double-contrast examination. Gastrointest Radiol. 1983; 8:207–212. PMID: 6618085.
Article
6. Megibow AJ, Balthazar EJ, Hulnick DH, Naidich DP, Bosniak MA. CT evaluation of gastrointestinal leiomyomas and leiomyosarcomas. AJR. 1985; 144:727–731. PMID: 3872029.
Article
7. Massari M, Lattuada E, Zappa MA, et al. Evaluation of leiomyoma of the esophagus with endoscopic ultrasonography. Hepatogastroenterology. 1997; 44:727–731. PMID: 9222681.
8. Pelot D. Haurich WS, Schaffner F, Berk JE, editors. Anatomy, anomalies, and physiology of the esophagus. Bockus Gastroenterology. 1995. 5th ed. Philadelphia: Saunders;p. 397–411.
9. Evans HL. Smooth muscle tumors of the gastrointestinal tract. A study of 56 cases followed for a minimum 10 years. Cancer. 1985; 56:2242–2250. PMID: 4052969.
10. Lewis B, Maxfield RG. Leiomyoma of the esophagus: Case report and review of the literature. Int Abstr Surg. 1954; 99:105–128. PMID: 13187207.
11. Godard JE, McCranie D. Multiple leiomyomas of the esophagus. AJR. 1973; 117:259–262.
Article
12. Levine MS, Buck JL, Pantongrag-Brown L, Buetow PC, Lowry MA, Sobin LH. Esophageal leiomyomatosis. Radiology. 1996; 199:533–536. PMID: 8668807.
Article
13. Rabushka LS, Fishman EK, Kulman JE, Hurban RH. Diffuse esophageal leiomyomatosis in a patient with Alport syndrome: CT demonstration. Radiology. 1991; 179:176–178. PMID: 2006273.
Article
14. Casillas J, Joseph RC, Guerra JJ. CT appearance of uterine leiomyomas. RadioGraphics. 1990; 10:999–1007. PMID: 2259770.
Article
15. Schnall MD. Gore RM, Levine MS, editors. Magnetic resonance imaging of the hollow viscera. Textbook of gastrointestinal radiology. 2000. 2nd ed. Philadelphia: Saunders;p. 86–97.
16. Totten RS, Stout AP, Humphreys GH, Moore RL. Benign tumors and cysts of the esophagus. J Thorac Surg. 1953; 25:606–622. PMID: 13062346.
Article
17. Storey CF, Adams WC. Leiomyoma of the esophagus: report of four cases and a review of the surgical literature. Am J Surg. 1956; 91:3–23. PMID: 13268774.
18. Seremetis MG, Lyons WS, de Guzman VC, et al. Leiomyomata of the esophagus: an analysis of 838 cases. Cancer. 1976; 38:2166–2177. PMID: 991129.
19. Seremetis MG, de Guzman VC, Lyons WS, et al. Leiomyoma of the esophagus: a report of 19 surgical cases. Ann Thorac Surg. 1973; 16:308–316. PMID: 4728612.
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