Esophageal leiomyoma is a benign smooth muscle neoplasm of the esophagus. It is the most common benign tumor of the esophagus.
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Epidemiology
It is most frequently presents in young and middle age groups (20-50 years). The overall incidence is around 8-43 per 10,000 autopsy series 4.
Clinical presentation
The clinical presentation would often depend on the size of a tumor:
- small tumors (<5 cm): usually no symptoms
- large tumors: may cause dysphagia, regurgitation, esophageal obstruction, chest pain, cough, or bleeding (rare)
Pathology
Like other leiomyomas, they comprise smooth muscle overgrowth.
Location
They typically involve the mid-to-distal esophagus 4.
Radiographic features
Fluoroscopy
On barium swallow, may be seen as a discrete ovoid mass that is well outlined by barium. Its borders form slightly obtuse angles with the esophageal wall.
CT
Findings include:
- ovoid intramural solitary mass with a smooth surface
- the presence of calcifications is almost pathognomonic
- narrowing of the esophageal lumen
- may displace the esophagus
- moderate diffuse contrast-enhancement
- no signs of invasion of adjacent tissue
Treatment and prognosis
The overall prognosis of these benign tumors is excellent. If a tumor is small (<5 cm) and asymptomatic treatment is not necessary. Otherwise, surgical enucleation is recommended 1,5.
Differential diagnosis
Imaging differential considerations include:
- esophageal GIST
- esophageal carcinoma
- esophageal leiomyosarcoma
- esophageal hamartoma
- other mediastinal tumors arising close to the esophagus
- foreign body
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