Keywords
Esophageal Resection
Esophagus
Surgery
How to Cite
Abstract
Background: Esophageal leiomyoma, which is usually slow-growing and non-invasive, can cause dysphagia, chest pain, regurgitation, and weight loss when it reaches large dimensions. Treatment varies according to the clinical picture, ranging from clinical observation to surgical enucleation. However, in extensive or complicated cases, esophagectomy may be necessary as a definitive approach. Aim: To report a case of esophagectomy in a patient with esophageal leiomyoma operated on in our Service.
Methodology: This is a case report of a patient treated at the General Surgery Service of the São Francisco na Providência de Deus University Hospital (HUSF), located in the city of Bragança Paulista, São Paulo, Brazil.
Case Report: A 40-year-old female patient presented with progressive dysphagia for 18 months, progressing to pasty foods, associated with weight loss of 15 kg in three months. Endoscopy and echoendoscopy revealed a large subepithelial lesion in the middle esophagus, with biopsy compatible with leiomyoma. Tomography showed a 4.5 cm mass occupying the esophageal lumen, without adjacent invasion. Esophagectomy was performed by video-assisted thoracoscopy and video-assisted laparoscopy, with reconstruction by gastric tube and gastroesophageal anastomosis in the cervical region. The patient progressed without complications, with a confirmed anatomopathological diagnosis of esophageal leiomyoma.
Conclusion: Although esophageal leiomyoma is a benign neoplasm, its clinical impact can be significant, especially in cases of delayed diagnosis or associated complications. Early diagnosis and timely surgical intervention favor simpler outcomes with lower morbidity, whereas late diagnoses and more complex approaches increase the risk of complications. Therefore, proper clinical recognition and individualized selection of the therapeutic strategy are essential to optimize the prognosis of these patients.
References
ABDUL-KARIM, Fadi W.; STURGIS, Charles. Differential Diagnoses in Surgical Pathology Tumors and their Mimickers E-Book: A Volume in the Foundations in Diagnostic Pathology series. Elsevier Health Sciences, 2023.
AGARWAL, Lokesh et al. Thoracoscopy-Assisted Esophagectomy for Esophageal Leiomyomatosis. Journal of Gastrointestinal Cancer, v. 55, n. 1, p. 193–197, 1 mar. 2024.
A-LAI, Gu-Ha et al. Surgical Treatment for Esophageal Leiomyoma: 13 Years of Experience in a High-Volume Tertiary Hospital. Frontiers in Oncology, v. 12, p. 876277, 2022.
ANNICCHIARICO, A. et al. McKeown oesophagectomy and pulmonary wedge resection with a prone thoracoscopic and laparoscopic approach: a video report. Annals of the Royal College of Surgeons of England, v. 103, n. 1, p. e4–e6, jan. 2021.
BEJI, Hazem et al. Leiomyoma of the esophagus: A case report and review of the literature. International Journal of Surgery Case Reports, v. 94, p. 107078, maio 2022.
CHOI, Yoon Jin; PARK, Sung Yong. Symptomatic Esophageal Leiomyoma. The Korean Journal of Gastroenterology - Taehan Sohwagi Hakhoe Chi, v. 77, n. 5, p. 258–260, 25 maio 2021.
DAS, Prasenjit; MAJUMDAR, Kaushik; GUPTA, Siddhartha Datta. Surgical Pathology of the Gastrointestinal System: Volume I - Gastrointestinal Tract. Springer Nature, 2022.
DU, Zhiqiang; DING, Wenjuan; CHEN, Tianming. Suitability and efficacy of submucosal tunneling endoscopic resection for the treatment of giant leiomyoma in the middle and lower esophagus. Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus, v. 32, n. 12, p. doz059, 31 dez. 2019.
ELBAWAB, Hatem et al. Giant Esophageal Leiomyoma: Diagnostic and Therapeutic Challenges. The American Journal of Case Reports, v. 22, p. e934557, 18 nov. 2021.
HALPERN, Alex I. et al. Submucosal Tunneling and Endoscopic Resection of an Esophageal Leiomyoma in a 13-Year-Old Male. Annals of Surgical Oncology, 21 jul. 2025.
HAMID, Gamal Abdul. Soft Tissue Sarcoma and Leiomyoma - Diagnosis, Management, and New Perspectives: Diagnosis, Management, and New Perspectives. BoD – Books on Demand, 2024.
HERBELLA, Fernando A. M.; PATTI, Marco G. Atlas of Esophageal Surgery. Springer Nature, 2022.
KHARLAMOVA, Olga; ZHAYVORONOK, Maksym. Esophageal Leiomyoma: Case Report. Ultrasound International Open, v. 10, p. a22216110, 2024.
KIM, SangMin et al. Minimally invasive resection of esophageal leiomyoma: 24 year experience. Surgical Endoscopy, 10 out. 2025.
MATHEW, George; OSUENI, Azeberoje; CARTER, Yvonne M. Esophageal Leiomyoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025.
MATHEW, Rishi Philip et al. Uterine leiomyomas revisited with review of literature. Abdominal Radiology, v. 46, n. 10, p. 4908–4926, 1 out. 2021.
MIETTINEN, Markku. Smooth muscle tumors of soft tissue and non-uterine viscera: biology and prognosis. Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc, v. 27 Suppl 1, n. Suppl 1, p. S17-29, jan. 2014.
MILITO, Pamela et al. Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, v. 24, n. 3, p. 499–504, mar. 2020.
MISRA, Monali et al. Esophageal leiomyomatosis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, v. 9, n. 11, p. CS98-101, nov. 2003.
MUTRIE, Christopher J. et al. Esophageal leiomyoma: a 40-year experience. The Annals of Thoracic Surgery, v. 79, n. 4, p. 1122–1125, abr. 2005.
SCHLOTTMANN, Francisco et al. Esophageal Cancer: Diagnosis and Treatment. Springer Nature, 2023.
SHANG, Qi-Xin et al. Missed diagnosis of esophageal leiomyoma leading to esophagectomy: a case report and review of literatures. Journal of Thoracic Disease, v. 10, n. 1, jan. 2018.
SHARZEHI, Kaveh; SETHI, Amrita; SAVIDES, Thomas. AGA Clinical Practice Update on Management of Subepithelial Lesions Encountered During Routine Endoscopy: Expert Review. Clinical Gastroenterology and Hepatology, v. 20, n. 11, p. 2435- 2443.e4, 1 nov. 2022.
ZAHEER, Atif; RAMAN, Siva P. Diagnostic Imaging: Gastrointestinal - E-Book: Diagnostic Imaging: Gastrointestinal - E-Book. Elsevier Health Sciences, 2022.
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