Answer of November 2011

Clinical History:

Middle age male, OGD found a smooth bulging at mid oesophagus, EUS reveals a well defined sub-mucosal mass. CT was performed. (8 images: axial pre-contrast x 1, axial post-contrast x 1, coronal post-contrast x 6) 

Diagnosis:

Esophageal leiomyoma

Discussion:

Leiomyoma is a benign neoplasm. It is the commonest intramural tumor of oesophagus (1,2). The quoted incidence is 0.006 – 0.10% (1). Oesophageal leiomyoma accounts for 10% of all the leiomyomas arising from the gastrointestinal tract (1). Esophageal leiomyoma can be multiple (1-3). It can be associated with Alpert syndrome (2), vulval leiomyoma and hypertrophic oestoarthropathy (3).
Leiomyoma can be detected on plain radiograph, contrast swallow, CT, MRI, endoscopy and endoscopic ultrasound (EUS). They are intramural tumors so their margin typically makes an obtuse angle with the oesophageal wall. They may contain punctuate or amorphous calcification (2, 3).
Oesophageal leiomyoms can be asymptomatic, while it may also cause symptoms such as epigastric discomfort, dysphagia, regurgitation and rarely GI bleeding (1). Asymptomatic oesophageal leiomyomas can be managed conservatively while symptomatic lesions can be removed by surgery (1)