Oesophageal leiomyoma: A case report

A 39-year-old woman presented with progressive heartburn and reflux of approximately 1 year’s duration. She complained of episodic dull retrosternal pain, but no associated dysphagia, haematemesis or weight loss. There was no relief with simple antacids and a physical examination was unremarkable. Initial endoscopy by a gastroenterologist revealed a mass in the distal oesophagus estimated at 2 cm with the appearance of a leiomyoma. There was also a 2-cm hiatus hernia with low-grade oesophagitis. The endoscopy was otherwise unremarkable. The patient was commenced on a proton pump inhibitor, and referred for surgical review. An endoscopic ultrasound (EUS) revealed a 3 cm × 4.4 cm hypoechoic mass in the distal oesophagus. The mass involved the muscularis propria layer and extended to the adventitia. There were areas of mixed echogenicity. The computed tomography (CT) scan showed no evidence of oesophageal obstruction or local invasion (Fig. 1). Manometric studies measured resting oesophageal pressure at 8 mmHg (normal range 12–25 mmHg) but otherwise function was normal. A transabdominal oesophagogastrectomy was performed via a midline laparotomy. The oesophagus was transected 3 cm above the tumour and distally transected just below the cardia. A stapled oesophagogastric anastomosis was performed. A large pedunculated leiomyoma was seen protruding through the left lateral portion of the distal third of the oesophagus (Figs 2,3). Histopathological examination confirmed leiomyoma, with two separate lobulated and well-circumscribed tumour masses. The larger one measured 45 mm × 33 mm × 25 mm, and the smaller one measured 16 mm × 14 mm × 12 mm with a diameter of 45 mm. Both were confined to the muscularis propria with no evidence of malignancy. There was little cellular pleomorphism and a mitotic count of fewer than 1 in 10 per high-powered field (HPF). Immunohistopathology showed eosinophilic cells, which were positive for desmin and actin but negative for CD34. CD117 and c-kit were not available. The patient made a rapid postoperative recovery, but required subsequent oesophageal dilations.