Esophageal Leiomyoma Symptoms, Causes, Radiology, Treatment

Myometrium is a common site for smooth muscle tumors known as leiomyomas. Submucosal leiomyomas in premenopausal women can manifest as abdominal or adnexal masses and are a significant contributor to infertility and irregular uterine hemorrhage. Uterine leiomyomas have the potential to grow extremely large, frequently exhibit hypocellular fibrosis (hyalinization), and may develop dystrophic calcification. 

Leiomyomas of the esophagus typically originate in the muscularis propria, where they develop into intramural masses. Although uncommon, esophageal leiomyomas can sometimes take the appearance of polyps. When compared to polypoid leiomyomas, intramural leiomyomas typically develop into considerably bigger masses. Small intestine and stomach leiomyomas are uncommon and typically intramural.

It is possible for leiomyomas in the uterus to progress into leiomyosarcomas, which are uncommon, malignant smooth muscle tumors. The presence of necrosis inside the tumor and the mitotic rate are both significant markers of malignancy in smooth muscle tumors. Hysterectomy specimens can be evaluated grossly for necrosis, which is a valuable screening technique. In most cases, a leiomyosarcoma is diagnosed when there are more than 10 mitotic figures per ten high-power fields within the tumor. On the other hand, tumors with an average number of mitotic figures are generally classed as smooth muscle tumors of unknown malignant potential.

Esophageal Leiomyoma Symptoms

When they are less than 5 cm in diameter, esophageal leiomyomas rarely exhibit symptoms. The symptoms experienced by patients typically increase as the size of these tumors increases. The most common symptoms include difficulty swallowing, chest pain, a vague sensation in the retrosternal region, reflux, and occasional regurgitation. Tumor erosion through the mucosa of the gastrointestinal tract is a rare but serious complication. Physical signs are absent, aside from the vague and poorly localized symptoms related to esophageal leiomyomas.

Esophageal Leiomyoma Causes

It is currently unknown what exactly causes this disorder; however, it is thought to be caused by hereditary factors as well as hormone imbalances. The majority of those affected by esophageal leiomyoma are between the ages of 40 and 60, suggesting that aging may potentially be a significant factor in this disorder. Due to their greater estrogen levels, female patients tend to be more at risk than male patients, while the incidence rate remains low overall. In addition, research has shown a correlation between exposure to environmental toxins and an increased likelihood of developing this condition. In order to comprehend the underlying pathophysiology of esophageal leiomyoma, research into its causes is still underway.

Esophageal Leiomyoma Radiology

There is a wide variety of clinical characteristics, pathologic findings, and imaging presentations that can be associated with esophageal neoplasms. Leiomyomas are the most prevalent type of benign tumor that can be seen in the esophagus. They often take the form of smooth-margined intramural masses. When esophageal peristalsis pulls them inferiorly, fibrovascular polyps that develop in the cervical esophagus eventually lengthen. Granular cell tumors typically present as accidental, tiny intramural lumps that resemble leiomyomas in appearance. 

Esophageal Leiomyoma Treatment

Regardless of tumor size, there is no consensus on treatment strategy. Excision or enucleation of the tumor is therefore recommended for all patients who present with symptomatic tumors. An open thoracotomy has been the method of choice for surgical procedures in the past. The tumor is then removed via esophageal myotomy, enucleation, or esophageal resection. Giant esophageal leiomyomas and tumors with lengthy esophageal segments may also require resection of the esophagus. Atelectasis and wound discomfort are the two main complications of an open thoracotomy technique. The last few years have seen a gradual increase in the acceptability of less invasive techniques like video-assisted thoracoscopic surgery (VATS).