Midwestern University, Mountain Vista Medical Center Spokane, WA, United States
Matthew Hillam, DO1, Preeyanka Sundar, MD, MPH1, Tushar Gohel, MD, CNSC2 1Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 2Reddy GI Associates, Gilbert, AZ; Midwestern University, Mountain Vista Medical Center, Mesa, AZ
Introduction: Leiomyomas arising in the esophagus are rare, accounting for 10% of all gastrointestinal leiomyomas, and are the most common benign intramural tumors of the esophagus. Typically found in patients ages 20 to 50 years old and in men vs. women by a ratio of 2:1, with 80% occur in the lower two-thirds. Symptomatic leiomyomas as in our patient are atypical and this case study brings light to this finding.
Case Description/Methods: 63-year-old male with history of benign mediastinal lymphadenopathy, granulomatous disease, and lymphocytic colitis, presented with recurrent painful swollen supraclavicular lymph nodes and new progressive dysphagia with night sweats over the past 3 months. CT showed a new mass-like thickening of the mid esophagus with coarse calcification concerning for esophageal carcinoma with previous multiple mildly prominent bilateral axillary, mediastinal, and left supraclavicular lymph nodes. An upper endoscopy (EGD) 2 months prior showed normal esophagus. Repeat EGD was performed without abnormal findings. He then underwent endoscopic ultrasound with finding of a 1.7x1.5 cm lesion with calcification arising from the muscularis propria. Fine needle biopsy was performed of the lesion showing spindle cell proliferates with myoid differentiation consistent with leiomyoma. Patient was managed conservatively and to have surveillance in 1 year if symptoms persist.
Discussion: Leiomyomas are slow-growing benign lesions with low malignant potential portending a good prognosis. In asymptomatic patients there is no further need for surveillance. Historically, surgical resection of these tumors was first line, however, with newer advanced endoscopic techniques the first line treatment is not as clear. In general, it appears lesions smaller than 5-10 mm may be observed based on patient symptoms. Endoscopic resection has been performed for lesions up to 4cm at specialized centers. This case is interesting as a symptomatic leiomyoma in the esophagus remains a rare diagnosis, and surveillance is not well delineated. The history of granulomatous disease, which had caused lymphadenopathy, and a concurrent diagnosis of lymphocytic colitis managed on steroids also is an unusual constellation of diagnoses. While there has been no correlation between these conditions documented in the literature, it is interesting that such a rare tumor would show up in this setting and future documentation will aid in learning more about this atypical tumor’s associations.
Figure: A. Spindle cell proliferation with myoid differentiation. B. Calcifications arising from the muscularis propria in the upper esophagus on endoscopic ultrasound.
Disclosures: Matthew Hillam indicated no relevant financial relationships. Preeyanka Sundar indicated no relevant financial relationships. Tushar Gohel indicated no relevant financial relationships.
Matthew Hillam, DO1, Preeyanka Sundar, MD, MPH1, Tushar Gohel, MD, CNSC2. P0355 - Among the Masses: Not Your Average Esophageal Leiomyoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.