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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.
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)
Like other leiomyomas, they comprise smooth muscle overgrowth.
They typically involve the mid-to-distal esophagus 4.
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.
- 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.
Imaging differential considerations include:
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- 2. Mutrie CJ, Donahue DM, Wain JC et-al. Esophageal leiomyoma: a 40-year experience. Ann. Thorac. Surg. 2005;79 (4): 1122-5. doi:10.1016/j.athoracsur.2004.08.029 - Pubmed citation
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- 4. Yang PS, Lee KS, Lee SJ et-al. Esophageal leiomyoma: radiologic findings in 12 patients. Korean J Radiol. 2002;2 (3): 132-7. Free text at pubmed - Pubmed citation
- 5. Bonavina L, Segalin A, Rosati R et-al. Surgical therapy of esophageal leiomyoma. J. Am. Coll. Surg. 1995;181 (3): 257-62. Pubmed citation
- 6. Winant AJ, Gollub MJ, Shia J et-al. Imaging and clinicopathologic features of esophageal gastrointestinal stromal tumors. AJR Am J Roentgenol. 2014;203 (2): 306-14. doi:10.2214/AJR.13.11841 - Pubmed citation