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Agarwal L, Varshney VK, Jabbar S, Selvakumar B, Yadav T, Khera S. Thoracoscopy-Assisted Esophagectomy for Esophageal Leiomyomatosis. J Gastrointest Cancer 2024; 55:193-197. [PMID: 37803192 DOI: 10.1007/s12029-023-00974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Diffuse esophageal leiomyomatosis is a rare esophageal tumor characterized by circumferential thickening of smooth muscle layers of the entire esophagus. CLINICAL CASE: Herein, we describe the case of a 19-year-old girl, who presented with a history of long-standing dysphagia. On evaluation she was found to have diffuse esophageal leiomyomatosis and was managed successfully by thoracoscopy-assisted esophagectomy with intra-nodal indocyanine green injection. DISCUSSION In this report, we discuss the pre-operative workup and our surgical approach to managing this rare entity. We also discuss the available literature on the subject and the lessons learnt in managing this complex condition.
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Affiliation(s)
- Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India.
| | - Shabana Jabbar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India
| | - B Selvakumar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Basni Industrial Area, Phase-II, 342005, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Smooth Muscle Conditions of the Chest: A Clinical, Radiologic, and Pathologic Review. J Thorac Imaging 2020; 36:263-278. [PMID: 33165163 DOI: 10.1097/rti.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Smooth muscle conditions of the chest have diverse clinical and imaging manifestations and may involve nearly every thoracic structure. Differentiation among these conditions requires the integration of clinical, radiologic, and histopathologic data. Histologic examination in conjunction with immunohistochemistry is essential for differentiation from other spindle cell neoplastic mimics. Familiarity with these entities will ensure the inclusion of smooth muscle conditions in the differential diagnosis of thoracic soft tissue lesions and potentially guide the clinician in appropriate management. We review the clinical, imaging, and histopathologic features of thoracic smooth muscle-related conditions organized by the anatomic structures affected.
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Kuramochi M, Izawa T, Mori M, Shimamura S, Shimada T, Kuwamura M, Yamate J. Diffuse leiomyomatosis with circumferential thickening of the gastrointestinal wall, resembling human diffuse leiomyomatosis, in a young miniature dachshund. J Vet Med Sci 2019; 82:139-142. [PMID: 31852861 PMCID: PMC7041974 DOI: 10.1292/jvms.19-0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Leiomyoma is the most common mesenchymal tumor in the gastrointestinal (GI) tract.
Leiomyomas usually have a single or multinodular mass of various sizes, and affected
animals can develop alimentary symptoms depending on the location and size. A 3-year old
female miniature dachshund died after a history of refractory rectal prolapse,
esophagectasis and aspiration pneumonia. At necropsy, the GI wall at the gastroesophageal
and anorectal junctions was circumferentially thickened. Histologically, both GI lesions
were composed of bundles of well-differentiated smooth muscles without mass formation or
invasive growth. The neoplastic cells had little cellular atypia and low proliferative
activity, and were positive for α-smooth muscle actin. The lesions were diagnosed as
diffuse leiomyomatosis with circumferential thickening of the GI wall and has not been
described in the veterinary literature.
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Affiliation(s)
- Mizuki Kuramochi
- Laboratory of Veterinary Pathology, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Takeshi Izawa
- Laboratory of Veterinary Pathology, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Mutsuki Mori
- Laboratory of Veterinary Pathology, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Shunsuke Shimamura
- Veterinary Medical Center, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Terumasa Shimada
- Veterinary Medical Center, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Mitsuru Kuwamura
- Laboratory of Veterinary Pathology, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Jyoji Yamate
- Laboratory of Veterinary Pathology, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
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Aoyama J, Miyawaki Y, Kato T, Fujiwara N, Sugita H, Sato H, Yasuda M, Sakuramoto S, Yamaguchi S. Alport-leiomyomatosis syndrome requiring subtotal esophagectomy for refractory gastroesophageal reflux disease after childhood partial esophagogastrectomy: a case report. Gen Thorac Cardiovasc Surg 2019; 68:199-203. [PMID: 31758390 DOI: 10.1007/s11748-019-01255-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/14/2019] [Indexed: 11/28/2022]
Abstract
Alport-leiomyomatosis syndrome is an extremely rare condition occurring at a young age in which Alport syndrome coexists with diffuse leiomyomatosis of the digestive tract (primarily the esophagus). Most patients with diffuse esophageal leiomyomatosis require esophagectomy of variable extents. A 20-year-old man with Alport-leiomyomatosis syndrome was diagnosed with dysphasia and hematuria in childhood. Although he underwent partial esophagogastrectomy at 8 years of age, extremely severe gastroesophageal reflux symptoms were noted postoperatively. He was diagnosed with refractory severe reflux esophagitis associated with diffuse leiomyomatosis and esophagogastric anastomosis, for which he underwent subtotal esophagectomy, gastric tube reconstruction, and esophagogastric anastomosis in the left neck. The postoperative course was generally good, and he had no postoperative reflux symptoms. To achieve long-term control of symptoms, the lesion must be removed completely; nevertheless, unnecessarily extensive esophagectomy should be avoided.
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Affiliation(s)
- Junya Aoyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
| | - Takuya Kato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naoto Fujiwara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hirofumi Sugita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Rapp JB, Ciullo S, Mallon MG. Diffuse esophageal leiomyomatosis: A case report with surgical correlation. Clin Imaging 2019; 58:161-165. [PMID: 31377438 DOI: 10.1016/j.clinimag.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
A 15 year old female with a history only significant for long standing dysphagia and intermittent chest pain underwent a screening chest radiograph. Findings of a large mass prompted cross sectional imaging where extensive and marked diffuse esophageal thickening was demonstrated. The patient ultimately underwent biopsy and surgical resection for diffuse esophageal leiomyomatosis. Diffuse leiomyomatosis of the esophagus has been described in the literature for about 100 years with increasing recognition in more recent times. There is a known association with inherited syndromes such as Alport and Esophageal-Vulvar syndrome, though some cases are sporadic. This case report will demonstrate the imaging features of diffuse esophageal leiomyomatosis utilizing multiple modalities including radiography, fluoroscopy, CT, and MRI, with surgical and pathologic correlation.
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Affiliation(s)
- Jordan B Rapp
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Sean Ciullo
- Department of Surgery, St. Christopher's Hospital for Children, Drexel University School of Medicine, Philadelphia, PA, USA
| | - Mary G Mallon
- Department of Radiology, St. Christopher's Hospital for Children, Drexel University School of Medicine, Philadelphia, PA, USA.
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Smirnov AA, Burakov AN, Shvetsov AN, Blinov EV, Semenikhin KD, Konkina NV, Dvoreckij SY. Peroral Endoscopic Myotomy in Diffuse Thickened Esophageal Wall in an Adolescent. Case Rep Gastroenterol 2018; 12:497-503. [PMID: 30283283 PMCID: PMC6167675 DOI: 10.1159/000492212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/17/2018] [Indexed: 11/20/2022] Open
Abstract
Achalasia is an extremely rare pathology in children. Peroral endoscopic myotomy (POEM) is the gold standard for the surgical treatment of achalasia in adults, but only a limited number of cases of achalasia treatment using POEM in children have been published in the literature. Sometimes, high-resolution manometry signs of achalasia can mimic diffuse esophageal leiomyoma. This case report represents the first known successful performance of POEM on a 15-year-old female with diffuse thickening of the esophagus with signs and symptoms of achalasia and suspicion for Alport syndrome associated with diffuse esophageal leiomyoma.
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Affiliation(s)
- Alexander A Smirnov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Aleksandr N Burakov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Aleksandr N Shvetsov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Egor V Blinov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Kirill D Semenikhin
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Nadezhda V Konkina
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Sergey Y Dvoreckij
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
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Hinshaw A, El-Baba M. A 7-Year-Old Boy With Alport Syndrome and Vomiting. Gastroenterology 2018; 155:e15-e16. [PMID: 29409873 DOI: 10.1053/j.gastro.2018.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Amie Hinshaw
- Children's Hospital of Michigan, Detroit, Michigan
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Berenguer Francés MÁ, Onrubia Pintado JA, Vázquez Pérez G. [Diffuse esophageal leiomyomatosis as a differential diagnosis of dysphagia]. Med Clin (Barc) 2016; 147:377-378. [PMID: 27450166 DOI: 10.1016/j.medcli.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/13/2016] [Accepted: 06/02/2016] [Indexed: 12/08/2022]
Affiliation(s)
| | | | - Gabriel Vázquez Pérez
- Servicio de Oncología Radioterápica, Hospital Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
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