Sawa Takayuki, Dohi Osamu, Iwai Naoto, Yamauchi Katsuma, Seya Mayuko, Miyazaki Hajime, Fukui Hayato, Kitae Hiroaki, Ishida Tsugitaka, Itoh Yoshito
Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Case Rep Gastroenterol. 2025 Mar 12;19(1):146-152. doi: 10.1159/000543564. eCollection 2025 Jan-Dec.
Esophageal leiomyomas are relatively common benign esophageal submucosal tumors (SMTs). Generally, benign tumors do not accumulate fluorine-18-fluorodeoxyglucose (FDG), but it is not rare for FDG to accumulate in uterine, duodenal, or esophageal leiomyomas. In our case, we performed peroral endoscopic tumor resection (POET) for an esophageal leiomyoma with FDG accumulation.
A 40-year-old female with a history of surgery for right breast cancer underwent fluorine-18-fluorodeoxyglucose-positron emission tomography for surveillance examination and had no specific symptoms or notable clinical findings. A subepithelial tumor with intense FDG uptake (SUVmax, 5.49) was detected in the middle thoracic esophagus. The lesion appeared as a low-absorption area on contrast-enhanced CT and was confirmed to have an equivalent signal level as muscle tissue on MRI T2WI. Endoscopic examination revealed SMT 25 cm from the incisors. Endoscopic ultrasonography (EUS) revealed a 20 mm low-luminance mass, mainly located in the second and third layers. The histopathology diagnosis by EUS-fine-needle aspiration was leiomyoma. We decided to treat it with POET because malignancy could not be ruled out. The tumor was excised en bloc using POET without severe complications. The tumor diameter was 19 × 15 mm, and disordered spindle cells were observed. Desmin and αSMA were positive, and S100 protein was negative on immunohistochemical study. Therefore, the pathological diagnosis was a leiomyoma.
In the present case, glucose transporter 1 expression was negative; however, we examined why the leiomyoma accumulated FDG. We suggest that awareness of leiomyoma with the accumulation of FDG exists in clinical practice.
食管平滑肌瘤是相对常见的食管良性黏膜下肿瘤（SMT）。一般来说，良性肿瘤不会摄取氟-18-氟脱氧葡萄糖（FDG），但FDG在子宫、十二指肠或食管平滑肌瘤中摄取并不罕见。在我们的病例中，我们对一例有FDG摄取的食管平滑肌瘤进行了经口内镜肿瘤切除术（POET）。
一名40岁女性，有右乳腺癌手术史，接受氟-18-氟脱氧葡萄糖正电子发射断层扫描进行监测检查，无特定症状或显著临床发现。在胸段食管中部检测到一个FDG摄取强烈（SUVmax，5.49）的上皮下肿瘤。该病变在增强CT上表现为低吸收区，在MRI T2WI上证实与肌肉组织信号水平相当。内镜检查显示距门齿25 cm处有SMT。内镜超声（EUS）显示一个20 mm的低亮度肿块，主要位于第二层和第三层。EUS细针穿刺活检的组织病理学诊断为平滑肌瘤。由于不能排除恶性肿瘤，我们决定采用POET治疗。使用POET整块切除肿瘤，无严重并发症。肿瘤直径为19×15 mm，观察到梭形细胞排列紊乱。免疫组化研究显示结蛋白和αSMA阳性，S100蛋白阴性。因此，病理诊断为平滑肌瘤。
在本病例中，葡萄糖转运蛋白1表达为阴性；然而，我们研究了该平滑肌瘤摄取FDG的原因。我们建议临床实践中应认识到有FDG摄取的平滑肌瘤。
