Esophageal leiomyoma: a 40-year experience

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Esophageal leiomyomas are the most frequent benign intramural esophageal tumors.
• They constitute 10% of all gastrointestinal leiomyomas and often require surgical intervention due to symptoms.

Purpose of the Study:

• To analyze the clinical characteristics and outcomes of patients undergoing surgical resection for esophageal leiomyomas.
• To determine the relationship between tumor size and symptomatology.
• To evaluate the efficacy and safety of surgical management.

Main Methods:

• A retrospective review of the Massachusetts General Hospital Pathologic Database over 40 years.
• Analysis of 53 patients who underwent surgical resection for esophageal leiomyomas.
• Data collected included demographics, symptoms, tumor characteristics, diagnostics, and treatment outcomes.

Main Results:

• Over half of the patients (31/53) were symptomatic, presenting at a mean age of 44 with a male predominance.
• Symptomatic leiomyomas were significantly larger (mean 5.3 cm) than asymptomatic ones (mean 1.5 cm).
• Most symptomatic lesions were solitary, located in the lower esophagus, and presented with epigastric discomfort. Surgical enucleation was successful in 97% of cases without recurrence or malignancy.

Conclusions:

• Symptomatic esophageal leiomyomas are common, with larger tumors more frequently causing symptoms.
• Local enucleation is an effective and safe treatment, providing complete symptom relief without perioperative complications.
• Esophageal leiomyomas have no observed tendency for malignant transformation or recurrence after resection.