Wong Thanawin, Pattarapuntakul Tanawat, Keeratichananont Suriya, Cattapan Kamonwon, Nirattisaikul Sitang, Wetwittayakhlung Poowadon
Division of Gastroenterology and Hepatology, Internal Medicine Department, Songklanagarind hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Case Rep Gastroenterol. 2021 Sep 27;15(3):861-868. doi: 10.1159/000518861. eCollection 2021 Sep-Dec.
Esophageal leiomyoma is uncommon. However, this tumor is the most common subepithelial tumor affecting the esophagus, comprising approximately two-thirds of benign esophageal tumors. Leiomyomas of the esophagus rarely cause symptoms when they are single and <5 cm. The mainstay of treatment is esophagectomy for symptomatic patients. A 68-year-old male patient presented with progressive dysphagia for 4 months. The degree of dysphagia and chest discomfort was more severe on solid rather than liquid diet. The CT scan of the chest showed multiple well-defined, submucosal nodules, up to 1.9 cm in diameter located at the middle esophagus. The barium swallow study illustrated multiple, well-defined, smooth, semilunar filling defects along the mid to distal esophagus. Meanwhile, esophagogastroduodenoscopy revealed 8 smooth subepithelial masses. Moreover, the radial EUS showed multiple hypoechoic masses arising from the 4th layer, with some of the tumors connected to others as a horseshoe-like shape causing narrowed lumen. Last, high-resolution esophageal manometry revealed ineffective esophageal motility. We report a rare case of numerous esophageal leiomyomas which caused dysphagia as a result of both mechanical obstruction and hypomotility disorder. The histopathology confirmed the diagnosis of esophageal leiomyoma. Symptoms improved significantly after lifestyle modifications and adherence to dietary advice on the part of the patient.
食管平滑肌瘤并不常见。然而，这种肿瘤是影响食管的最常见的上皮下肿瘤，约占食管良性肿瘤的三分之二。食管平滑肌瘤单发且直径<5 cm时很少引起症状。有症状患者的主要治疗方法是食管切除术。一名68岁男性患者出现进行性吞咽困难4个月。固体食物比液体食物导致的吞咽困难和胸部不适程度更严重。胸部CT扫描显示多个边界清晰的黏膜下结节，位于食管中段，直径达1.9 cm。吞钡造影显示食管中下段有多个边界清晰、光滑的半月形充盈缺损。同时，食管胃十二指肠镜检查发现8个光滑的上皮下肿物。此外，超声内镜显示多个起源于第4层的低回声肿物，部分肿瘤相互连接呈马蹄形，导致管腔狭窄。最后，高分辨率食管测压显示食管动力障碍。我们报告一例罕见的多发食管平滑肌瘤病例，该病例因机械性梗阻和动力障碍导致吞咽困难。组织病理学确诊为食管平滑肌瘤。患者改变生活方式并遵循饮食建议后，症状明显改善。
