Endoscopic Submucosal Dissection of a Leiomyoma Originating from the Muscularis Propria of Upper Esophagus

Myung Soo Kang; Su Jin Hong; Jae Pil Han; Jung Yeon Seo; La Young Yoon; Moon Han Choi; Hee Kyung Kim

doi:10.4166/kjg.2013.62.4.234

Journal List > Korean J Gastroenterol > v.62(4) > 1007147

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Kang, Hong, Han, Seo, Yoon, Choi, and Kim: Endoscopic Submucosal Dissection of a Leiomyoma Originating from the Muscularis Propria of Upper Esophagus

Case Report

Korean J Gastroenterol 2013;62(4):234-237.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.4.234

Endoscopic Submucosal Dissection of a Leiomyoma Originating from the Muscularis Propria of Upper Esophagus

Myung Soo Kang, Su Jin Hong, Jae Pil Han, Jung Yeon Seo, La Young Yoon, Moon Han Choi, Hee Kyung Kim¹

Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea

¹Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea

Correspondence to: Su Jin Hong, Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea. Tel: +82-32-621-5087, Fax: +82-32-621-5080, E-mail: sjhong@schmc.ac.kr

Received 4 February 2013 Revised 7 March 2013 Accepted 20 March 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The technique of endoscopic submucosal dissection is occasionally used for resection of myogenic tumors originating from muscularis mucosa or muscularis propria of stomach and esophagus. However, endoscopic treatments for esophageal myogenic tumors >2 cm have rarely been reported. Herein, we report a case of large leiomyoma originating from muscularis propria in the upper esophagus. A 59-year-old woman presented with dysphagia. Esophagoscopy and endoscopic ultrasonography revealed an esophageal subepithelial tumor which measured 25×20 mm in size, originated from muscularis propria, and was located at 20 cm from the central incisors. The tumor was successfully removed by endoscopic submucosal dissection and there were no complications after en bloc resection. Pathologic examination was compatible with leiomyoma.

Keywords: Endoscopic submucosal dissection, Leiomyoma, Esophagus, Muscularis propria

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Fig. 1.

(A) Axial image of chest CT scan demonstrates a 2.5×2.2 cm sized heterogeneously enhancing round mass in the upper esophagus. (B) Sagittal image also reveals esophageal mass.

Fig. 2.

(A) Esophageal subepithelial tumor was located in the upper esophagus. (B) Endoscopic ultrasonography showed that the tumor originated from muscularis propria. (C) IT knife was used to peel the muscularis propria layer along the edge of the tumor. (D) The tumor with its capsule was successfully enucleated. (E) Longitudinal muscle fibers and adventitia could be observed after removal of the tumor. (F) The wound was closed by metal clips.

Fig. 3.

(A) The resection margin was negative as indicated by the location of black-ink outside the capsule of resected tumor (H&E, ×20). (B) Microscopically, the tumor was composed of irregularly oriented bundles of slender tapered smooth muscle cells (H&E, ×100). (C) Immunohistochemical stain for desmin revealed positivity in the tumor cells (×200).

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