Benign tumors


Topic Completed: 1 January 2013

Minor changes: 17 December 2020

Copyright: 2003-2021,, Inc.

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

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Leiomyoma. website. Accessed October 22nd, 2021.
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
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

AFIP images

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

AFIP images

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)
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