ESOPHAGUS LEIOMYOMA IN AN ELDERLY PATIENT WITH ENDOSCOPIC RESECTION: A CASE REPORT

Abstract

Case Presentation: Patient A.M.F., a 79-year-old male, asymptomatic, sought care for investigation of a urinary tract infection. A computed tomography scan of the abdomen revealed a lesion near the esophageal region, raising suspicion of GIST (Gastrointestinal Stromal Tumor). Upper gastrointestinal endoscopy and magnetic resonance imaging of the upper abdomen were requested. Endoscopy revealed an ill-defined bulge in the distal esophagus extending to the gastric cardia. MRI revealed an intramural lesion affecting the distal esophagus and gastric cardia, suggesting a GIST. Upper endoscopic ultrasound was requested to evaluate the peri-esophageal lesion and aspiration punctures for biopsy. Immunohistochemical studies confirmed the diagnosis of leiomyoma. The patient underwent successful endoscopic resection of the tumor. The patient progressed well. Discussion: Esophageal leiomyoma, although the most common benign tumor of the esophagus, is rare and usually asymptomatic, often diagnosed incidentally. Its main differential diagnosis is gastrointestinal stromal tumor (GIST), due to the similar radiological and endoscopic characteristics. In the present case, the initial suspicion of GIST was ruled out after endoscopic ultrasound with fine needle aspiration and immunohistochemical study, which confirmed the diagnosis of leiomyoma. Endoscopic resection is considered a safe and effective option for small, well-defined tumors, offering lower morbidity and faster recovery compared to traditional surgical techniques. This case reinforces the importance of a multimodal diagnostic approach for subepithelial lesions, ensuring appropriate treatment and a better prognosis. Final Comments: The diagnosis of esophageal leiomyoma is difficult due to the absence of symptoms or the presence of nonspecific symptoms in some patients, and it is often detected incidentally during routine examinations. Open thoracotomy is the standard treatment, with enucleation or esophageal resection performed depending on the location and size of the tumor, the presence of metastasis, and the degree of mucosal invasion. Furthermore, less invasive treatments have also proven effective due to their reduction in postoperative complications and hospital stay. Therefore, it can be concluded that routine examinations are essential for tumor detection and surgical treatment.