Esophageal leiomyoma within an epinephric diverticulum

Epinephric diverticula are distal esophageal pouches protruding from the epithelial lining of the esophagus while esophageal leiomyomas are benign smooth muscle lesions that constitute a significant percentage of all gastrointestinal leiomyomas. Epinephric diverticula and esophageal leiomyomas are common individually but their co-existence is rare. Moreover, they present asymptomatically but can occasionally present with complains of dysphagia and weight loss. In this paper, we present a 58-year-old Asian man with three months history of indigestion and progressive weight loss. Preoperatively, CT Scan with IV Contrast showed a large soft tissue mass appearing on the right distal esophageal wall, with its lumen communicating with the esophageal lumen, likely representing an epinephric diverticulum. Biopsy and immunohistochemistry stains confirmed the diagnosis of smooth muscle neoplasm, likely a leiomyoma. Later, the patient underwent a two-stage esophagectomy. The postoperative biopsy was consistent with the initial one: therefore, supporting the diagnosis of a leiomyoma. Postoperatively, the recovery remained uneventful.