Korean J Gastroenterol.  2013 Oct;62(4):234-237. 10.4166/kjg.2013.62.4.234.

Endoscopic Submucosal Dissection of a Leiomyoma Originating from the Muscularis Propria of Upper Esophagus

• Kang MS
• Hong SJ
• Han JP
• Seo JY
• Yoon LY
• Choi MH
• Kim HK

• KMID: 1792742
• DOI: http://doi.org/10.4166/kjg.2013.62.4.234

Abstract

The technique of endoscopic submucosal dissection is occasionally used for resection of myogenic tumors originating from muscularis mucosa or muscularis propria of stomach and esophagus. However, endoscopic treatments for esophageal myogenic tumors >2 cm have rarely been reported. Herein, we report a case of large leiomyoma originating from muscularis propria in the upper esophagus. A 59-year-old woman presented with dysphagia. Esophagoscopy and endoscopic ultrasonography revealed an esophageal subepithelial tumor which measured 25x20 mm in size, originated from muscularis propria, and was located at 20 cm from the central incisors. The tumor was successfully removed by endoscopic submucosal dissection and there were no complications after en bloc resection. Pathologic examination was compatible with leiomyoma.

Keyword

Endoscopic submucosal dissection; Leiomyoma; Esophagus; Muscularis propria

MeSH Terms

Esophageal Neoplasms/*diagnosis/pathology/surgery
Esophagus/surgery/ultrasonography
Female
Gastroscopy
Humans
Leiomyoma/*diagnosis/pathology/surgery
Middle Aged
Mucous Membrane/pathology
Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. (A) Axial image of chest CT scan demonstrates a 2.5×2.2 cm sized heterogeneously enhancing round mass in the upper esophagus. (B) Sagittal image also reveals esophageal mass.

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  Fig. 2. (A) Esophageal subepithelial tumor was located in the upper esophagus. (B) Endoscopic ultrasonography showed that the tumor originated from muscularis propria. (C) IT knife was used to peel the muscularis propria layer along the edge of the tumor. (D) The tumor with its capsule was successfully enucleated. (E) Longitudinal muscle fibers and adventitia could be observed after removal of the tumor. (F) The wound was closed by metal clips.

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  Fig. 3. (A) The resection margin was negative as indicated by the location of black-ink outside the capsule of resected tumor (H&E, ×20). (B) Microscopically, the tumor was composed of irregularly oriented bundles of slender tapered smooth muscle cells (H&E, ×100). (C) Immunohistochemical stain for desmin revealed positivity in the tumor cells (×200).

Reference

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