Asian Cardiovasc Thorac Ann 2006;14:536
© 2006 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Enucleation of Giant Leiomyoma of the Esophagus
Georgios P Georghiou, MD,
Franklin Greif, MD1,
Alex Geller, MD2,
Bernardo A Vidne, MD,
Milton Saute, MD
Departments of Cardiothoracic Surgery,
1 Surgery A, and
2 Advanced Endoscopy Unit, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
For reprint information contact: Georgios P Georghiou, MD Tel.: 357 22 819 666 Fax: 357 22 819 667 Email: georgios{at}ahi.com.cy, Department of Cardiothoracic Surgery, American Heart Institute, 20 Lefkotheou Avenue, Nicosia 2054, Cyprus.
A 45-year-old man with a one-year history of intermittent dysphagia, normal laboratory, clinical, and abdominal sonography findings, and extrinsic compression of the midthoracic esophagus on barium swallow was found by endoscopic ultrasonography to have a mid-esophageal tumor (7 x 4 cm) arising in the fourth layer of the lamina propria (Figure 1A
), with no mucosal ulceration or tumor infiltration. Posterolateral compression of the trachea and mainstem bronchus to the left was confirmed by computed tomography (Figure 1B).
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Figure 1A. Endoscopic ultrasonography view from the mid-esophagus, the 41-mm mixed echogenic mass with distinct borders, consistent with a muscularis propria leiomyoma (arrows). MP = muscularis propria; E = endoscope.
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Figure 1B. Preoperative computed tomography scan showing excentric obstructive mass in the transition site from the upper to middle thoracic esophagus (double arrow). Single arrow = aorta; arrowhead = left inferior pulmonary vein.
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The thoracic esophagus was exposed via left thoracotomy. The mediastinal pleura was incised by electrocautery, and the affected esophageal area was mobilized circumferentially. The muscularis propria was divided by electrocautery to expose the submucosal esophageal tumor, which was enucleated by careful dissection. The esophageal wall was closed with simple interrupted sutures and protected with a pedunculate pleural flap. No part of the esophagus was excised. Frozen section excluded malignancy. Histologic study confirmed the diagnosis of leiomyoma.
