Esophageal Leiomyoma

Introduction

Background

Benign tumors of the esophagus are rare lesions that constitute less than 1% of esophageal neoplasms. Nearly two thirds of benign esophageal tumors are leiomyomas; the others mostly are polyps and cysts. Thus, leiomyomas are the most common benign tumors of the esophagus.

Pathophysiology

Leiomyomas represent a hyperproliferation 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.

Frequency

International

Esophageal leiomyomas comprise less than 0.6% of all esophageal neoplasms, both in the United States and worldwide.

Race

No known differences

Sex

No known differences

Age

Typically occur in individuals aged 20-50 years

Clinical

History

• Esophageal leiomyomas rarely cause symptoms when they are smaller than 5 cm in diameter.
• Large tumors can cause dysphagia, vague retrosternal discomfort, chest pain, esophageal obstruction, and regurgitation.
• Rarely, they can cause gastrointestinal bleeding, with erosion through the mucosa.

Physical

• Other than the nonspecific symptoms associated with esophageal leiomyomas, very few physical findings are ever noted.
• In extremely rare cases where severe esophageal obstruction is caused by a leiomyoma, weight loss and muscle wasting may be observed.