Diffuse esophageal leiomyomatosis with a pedunculated polyp

Although leiomyomas are the most common benign tumors of the esophagus, esophageal leiomyomatosis is a rare pathological entity, and pedunculated presentation is even rarer. A 61-year-old man was found, incidentally, to have an esophageal tumor on a survey of chest computed tomography (CT) examination for a pulmonary nodule. Endoscopy disclosed a pedunculated polyp covered by nearly normal esophageal mucosa, with surrounding annular extension of a submucosal elevation. Endoscopic ultrasonography (EUS) revealed a hypoechoic tumor, with a maximum diameter of 3 cm originating from the thickened muscularis mucosa layer. The underlying muscularis propria layer was also prominently thickened. The polypoid lesion was then removed by endoscopic resection with wire-loop ligation, followed by snare electrocoagulation. The pathological diagnoses of the polyp and the surrounding submucosal lesions were both leiomyoma. Diffuse esophageal leiomyomatosis was suspected in this situation because of the characteristic pathological distribution. In this patient, the EUS findings corresponded well to the characteristic features of diffuse esophageal leiomyomatosis noted in previous reports, and this was of great help for the diagnosis, in addition to the endoscopic findings. This case report is presented with a particular focus on the problems associated with accurate diagnosis.