Midwestern University, Mountain Vista Medical Center Mesa, AZ, United States
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Sara Ancello, DO3 1Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 2Mountain Vista Medical Center, Aldie, VA; 3Central Arizona Medical Associates, Mesa, AZ
Introduction: Colonic leiomyoma (CL) is a rare benign submucosal tumor, originating either from the muscularis mucosae or propria. Accounting for a mere 3% of all gastrointestinal (GI) smooth muscle tumors and 1% of primary GI cancers, it has a male predominance, typically in the fifth decade of life. Here, we report an unusual presentation of colonic leiomyoma.
Case Description/Methods: A 54-year-old male ex-smoker presented with right lower abdominal pain for 1 month, clinic workup was unrevealing. Eight years prior, he had an 8mmx7mm pedunculated tubular adenoma in the descending colon. Repeat colonoscopy showed a 2cmx3cm pedunculated multilobulated polypoid-like lesion in the transverse colon. Polyp was smooth, firm, pillow-sign negative, was lifted with Orise and endoscopic mucosal resection (EMR) performed; 3 clips were placed to close the defect. This transverse colon “polyp” was found to be a colonic leiomyoma, resection with clear margins.
Discussion: Leiomyomas were first described in 1854. CLs atypically have a pedunculated appearance, making accurate preoperative diagnoses challenging based merely on their morphology. This CL presented usually as a pedunculated polypoid lesion, incidence of the polypoid-nature of this submucosal tumor is unknown, only documented in case reports. Perforation is a common side effect of traditional polypectomy for CLs. Our case is an important contribution to the literature as polypoid CLs are unusual, often misdiagnosed as polyps, and may be successfully resected with EMR.
Figure: A-D, Colonoscopic images of 2cmx3cm pedunculated multilobulated polypoid-like lesion in the transverse colon with a smooth surface, and was firm, pillow sign negative. E-I, Polyp was lifted with Orise and endoscopic mucosal resection (EMR) was done and 3 clips were placed to close the defect. "Polyp" specimen was retrieved was found to be a colonic leiomyoma, resection with clear margins. J-L, Histological analysis revealed a dense proliferation of spindle cells with round to oval nuclei beneath the thin, normal mucosal epithelium. Rare mitoses seen. M-N, Cells were positive for desmin staining (C-kid, S-100 negativity noted).
Disclosures: Preeyanka Sundar indicated no relevant financial relationships. Suma Harsha Kosuru indicated no relevant financial relationships. Matthew Hillam indicated no relevant financial relationships. Sara Ancello indicated no relevant financial relationships.
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Matthew Hillam, DO1, Sara Ancello, DO3. P2294 - A Submucosal Avatar: An Interesting Intervention for an Unusual Pathology of Polypoid Colonic Leiomyoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.