Asian Cardiovasc Thorac Ann 2008;16:181-182
© 2008 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
A Large Horse Shoe-shaped Leiomyoma of the Thoracic Esophagus
Jubrail Dahabreh, PhD,
Apostolos Dountsis, MD,
Constantinos Vasilikos, MD,
Charalambos Zisis, PhD
Department of Thoracic Surgery Athens Medical Center Athens, Greece
For reprint information contact: Charalambos Zisis, PhD, Tel: 30 694 587 5222, Fax: 30 210 610 8740, Email: chzisis{at}hol.gr 17a, Patriarchou Grigoriou str, 166 74- Glyfada, Greece
A 31-year-old male presented with dysphagia. The barium swallow (Figure 1a
) showed an abnormality of the esophageal wall at the level of the carina, without any intraluminal pathologic finding. A right thoracotomy was performed and a large horse shoe-shaped leiomyoma was enucleated (Figure 2a and 2b). The patient recovered well and was discharged on the 5th postoperative day from the hospital. Postoperative esophageal gastrografin swallow is normal (Figure 1b).
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Figure 1. Abnormal barium swallow: (a) well-defined, smooth filling defect without mucosal ulceration at the level of the carina; (b) normal postoperative gastrografin swallow.
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Figure 2. (a) Surgical specimen showing a large horse shoe-shaped leiomyoma (12 x 2 x 2 cm); (b) tumor enucleated with intact mucosa; the esophagus is inflated to check the integrity of the mucosa. 1 = spinal cord, 2 = esophageal muscular layer, 3 = esophageal mucosa, 4 = atelectatic right lung.
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Over half of all esophageal leiomyomas, especially the larger ones, are symptomatic. The main complaint of the patient was dysphagia, which remitted after resection of the tumor. The issue of the potential malignant transformation of the tumor is controversial. Some authors have supported it, but it has not been confirmed in larger series. Perioperative morbidity is minimal and recurrence does not occur, if the resection is total. Thoracoscopic enucleation of esophageal leiomyomas has been successfully performed and has been reported in consecutive papers recently. The experience in this era is promising.
