Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

Hyun Ho Choi; Young-Seok Cho; Soo Kyoung Choi; Hyung-Keun Kim; Sung Soo Kim; Hiun-Suk Chae; Ok-Ran Shin

doi:10.4166/kjg.2016.68.4.179

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Choi, Cho, Choi, Kim, Kim, Chae, and Shin: Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

Original Article

Korean J Gastroenterol 2016;68(4):179-185.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.4.179

Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

Hyun Ho Choi, Young-Seok Cho¹, Soo Kyoung Choi, Hyung-Keun Kim, Sung Soo Kim, Hiun-Suk Chae, Ok-Ran Shin²

Department of Internal Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea

¹Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea

²Department of Hospital Pathology, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea

Correspondence to: Young-Seok Cho, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo- daero, Seocho-gu, Seoul 06591, Korea. Tel: +82-2-2258-6021, Fax: +82-2-2258-2038, E-mail: yscho@catholic.ac.kr

Received 17 June 2016 Revised 3 August 2016 Accepted 18 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Although polypoid leiomyomas in the colon and rectum are rare, they are increasingly detected during colonoscopy. The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic removal for colorectal polypoid leiomyoma.

Methods

Data were retrospectively collected from 22 patients with polypoid leiomyoma arising from the muscularis mucosae in the colon and rectum who underwent endoscopic removal at single referral gastrointestinal endoscopy unit. Colonoscopic findings, endoscopic removal, success rates, complication rates (bleeding or perforation), pathologic characteristics, and recurrence rates were investigated.

Results

Most polypoid leiomyomas were small asymptomatic lesions less than 1 cm. The tumors were located predominantly in the left colon. Ten leiomyomas were removed using cold biopsy forceps, and 12 were resected by conventional polypectomy or endoscopic mucosal resection. All tumors arose from or involved the muscularis mucosa. There were no complications, such as bleeding or perforation. No local remnant lesions were found in 19 patients who underwent at least one follow-up colonoscopy.

Conclusions

This case series represent cases of small colorectal polypoid leiomyoma that were safely removed endoscopically. An awareness of their endoscopic and clinic-pathological characteristics may provide safe treatment strategy for colonic leiomyomatous tumors of similar size in capable hands.

Keywords: Colorectal neoplasms, Colonic polyps, Leiomyoma, Colonoscopy

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Fig. 1.

Colonoscopic findings of polypoid leiomyomas. A typical leiomyoma (approximately 5-mm) presenting as smooth round sessile polyp (A), a 13-mm leiomyoma presenting as pedunculated polyp (B), and a 7-mm leiomyoma resembling a hyperplastic polyp (C).

Fig. 2.

A 12-mm pedunculated leiomyoma removed by endoscopic mucosal resection.

Fig. 3.

Histologic findings (H&E) showing well-circumscribed nodule arising from the muscularis mucosae (A, ×40) composed of well-differentiated smooth muscle cells (B, ×100). On immunohistochemistry, the tumor is positive for smooth muscle actin (C, ×100) and desmin (D, ×100).

Table 1.

Patient Demographics and Colonoscopic Findings

Case	Age (yr)	Sex	Location	Morphology	Size (mm)	Indication	Treatment	Other findings	Follow-up (mo)
1	34	M	DC	Sessile	4	Screening	Cold biopsy	None	NED (51)
2	53	M	Rectosigmoid	Sessile	3	Screening	Cold biopsy	None	NED (47)
3	43	M	TC	Sessile	3	Screening	Cold biopsy	None	NED (36)
4	60	M	AC	Pedunculated	13	Screening	EMR	None	NED (45)
5	50	M	Rectosigmoid	Sessile	6	Screening	EMR	2 hyperplastic polyps	NED (40)
6	66	F	TC	Sessile	7	Diarrhea	EMR	None	NED (38)
7	67	M	SC	Sessile	5	Abdominal discomfort	EMR	None	NED (37)
8	49	M	Rectosigmoid	Sessile	4	Screening	Cold biopsy	1 hyperplastic polyp	NA
9	50	F	SC	Sessile	6	Screening	EMR	None	NED (32)
10	62	M	SC	Sessile	8	Screening	EMR	1 adenoma	NED (27)
11	77	F	AC	Sessile	3	Diarrhea	Cold biopsy	3 adenomas; 3 hyperplastic polyps	NED (26)
12	41	M	Rectum	Sessile	3	Screening	Cold biopsy	1 hyperplastic polyp	NED (26)
13	49	M	SC	Sessile	8	Screening	EMR	None	NED (23)
14	60	M	DC	Pedunculated	7	Screening	EMR	2 adenomas	NA
15	66	M	Splenic flexure	Pedunculated	12	Rectal bleeding	EMR	2 adenomas; 1 adenocarcinoma, moderately differentiated	NED (20)
16	82	F	Rectosigmoid	Sessile	3	Altered bowel habits	Cold biopsy	1 adenoma	NA
17	44	M	DC	Pedunculated	7	Screening	EMR	1 adenoma; 1 hyperplastic polyp	NED (19)
18	55	M	SC	Sessile	4	Screening	Cold biopsy	None	NED (17)
19	36	M	SC	Pedunculated	9	Rectal bleeding	EMR	2 adenomas; 1 hyperplastic polyp	NED (15)
20	40	M	AC	Sessile	4	Screening	Cold biopsy	None	NED (15)
21	75	M	DC	Sessile	4	Screening	Cold biopsy	1 adenoma; 1 adenocarcinoma, well differentiated	NED (14)
22	74	M	Rectum	Sessile	5	Screening	EMR	1 adenoma	NED (14)

M, male; F, female; DC, descending colon; TC, transverse colon; AC, ascending colon; SC, sigmoid colon; EMR, endoscopic mucosal resection; NED, no evidence of disease; NA, not available.

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