Large Diameter Esophageal Leiomyomas

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Benigntumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Leiomyomas represent a hyper proliferation of interlacing bundles of smooth muscle cells that are well-demarcated by adjacent tissue or by a smooth connective tissue capsule. They usually arise as intramural growths, most commonly along the distal two thirds of the esophagus. They are multiple in approximately 5% of patients. The majority of leiomyomas have been discovered incidentally during evaluation for dysphagia or during autopsy. Bleeding rarely occurs in cases of benign disease but typically is observed with leiomyosarcoma, the malignant counterpart of this tumor. The potential for malignant degeneration of leiomyomas is extremely small. In the distal esophagus, leiomyomas may reach large proportions and may encroach on the cardia of the stomach.

Benigntumors of the esophagus are rare and leiomyoma is the most common benign tumor of the esophagus. It is reported that most leiomyomas originate the inner circular muscle layer of the distal and midthoracic esophagus, particularly at the esophagogastric junction. Middle-aged men are most frequently affected. The main symptoms usually are dysphagia and epigastric pain, but they are not specific for the disease. The size of the esophageal leiomyoma may change; a size of 1 to 29 cm has been defined in the literature. But most of them were smaller than 5 cm in diameter. Tumor that size larger than 7cm is rare. It was easily misdiagnosis as mediastinal mass, esophageal cancer and esophageal stromal tumor. Its clinical feature and management are different with other smaller esophageal leiomyoma. Here, a patient with large calcified esophageal leiomyoma who was treated in our institute is presented, initial discuss its diagnosis and management against the background of previously published cases and series.