Anterior and Posterior Mediastinum Leiomyomas Arising From the Parietal Pleura

A 72-year-old male patient was found with enlarged nodes in the anterior and posterior mediastinum on screening imaging studies of the chest. The anterior node appeared as a single cystic lesion without significant metabolic activity on scintigraphy images. The posterior node was a single solid lesion in the lower left periesophageal space above the diaphragmatic crura with moderate metabolic uptake. Endoscopic ultrasound allowed a transesophageal endosonography-guided fine needle aspiration of the posterior node. The anterior lesion was sampled via percutaneous transthoracic approach. Biopsy revealed aggregates of mesenchymal cells with spindle nuclei; immunohistochemistry confirmed two primary leiomyomas of the mediastinum.