Esophagus
Benign tumors
Leiomyoma

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 18 January 2018, last major update January 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Esophageal leiomyoma[TI] full text[sb]

Cite this page: Weisenberg, E. Leiomyoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusleiomyoma.html. Accessed May 27th, 2018.
Definition / general
Clinical features
  • Median age 35 years, 2/3 men, usually single, 24% multiple (seedling tumors)
  • Usually arises from inner circular muscle; most common in distal esophagus, rarely polypoid
  • Benign behavior (Ann Thorac Surg 2005;79:1122)
  • Minute (1 - 2 mm "seedling") tumors are often near the gastroesophageal junction and are asymptomatic
  • Multiple tumors are associated with MEN1 syndrome (Am J Pathol 2001;159:1121)
  • Large tumors may cause obstructive symptoms
Case reports
Treatment
Clinical images

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Endoscopic examination

Gross description
  • Circumscribed, mural, solitary mass, 2 - 5 cm (surgical specimens), bulges into lumen, may be polypoid
  • Pinkish gray white with whorled cut surface; mucosal surface is only rarely ulcerated
Gross images

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Bulging, white, whorled cut surface



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Submucosal tumor

With squamous cell carcinoma

Microscopic (histologic) description
  • Similar to classic endometrial leiomyoma; circumscribed lesion of circular muscularis propria or muscularis mucosae composed of intersecting fascicles of bland spindle cells with abundant cytoplasm
  • Variable fibrosis in center of large leiomyomas
  • Occasional calcification; no / rare mitotic figures; no atypia, no cellular foci
Microscopic (histologic) images

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Cluster of seedling leiomyomas

Seedling leiomyoma of muscularis propria

Leiomyoma with overlying squamous epithelium

Mature, hypertrophied smooth muscle cells


Multiple seedling leiomyomas

Leiomyoma of muscularis propria

Fascicular growth pattern



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Squamous cell carcinoma and leiomyoma

Cytology images

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Groups of spindled cells with low cellularity

Negative stains
Differential diagnosis
  • GIST: very rare; solid, myxoid and perivascular patterns; more cellular by H&E and cytology, CD117+, CD34+, variable desmin and actin immunoreactivity (Am J Surg Pathol 2000;24:211)