Are biopsies during endoscopic ultrasonography necessary for a suspected esophageal leiomyoma?Is laparoscopy always feasible?

The present letter to the editor is related to the work entitled“Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography-fine needle aspiration:A case report.”Although endoscopic ultrasonography seems necessary in a suspected leiomyoma of the esophagus,the performance of biopsies via fine needle aspiration is controversial as it increases the risk of complications such as bleeding,infection,and intraoperative perforations.Laparoscopy is the best treatment strategy for small tumors.Laparotomy with tumor enucleation or esophageal resection can be considered in large leiomyomas.

Surgical treatment of giant esophageal leiomyoma

AIM： To summarize the operative experiences for giant leiomyoma of esophagus.METHODS： Eight cases of giant esophageal leiomyoma （GEL） whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004.All of these cases received barium swallow roentgenography and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap （one case）, esophagectomy and esophagogastrostomy above the arch of aorta （three cases）, total esophagectomy and esophageal replacement with colon （four cases）. Histological examination confirmed that all of these cases were leiomyoma.RESULTS： All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophagogastrostomy and was alleviated with medication. Thoracic colon syndrome （TCS） occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years.CONCLUSION： Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophagogastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.

Thoracoscopic resection of a large lower esophageal schwannoma:A case report and review of the literature

BACKGROUND Esophageal schwannomas originating from Schwann cells are extremely rare esophageal tumors.They commonly occur in the upper and middle esophagus but less frequently in the lower esophagus.Herein,we report a rare case of a large lower esophageal schwannoma misdiagnosed as a leiomyoma.We also present a brief literature review on lower esophageal schwannomas.CASE SUMMARY A 62-year-old man presented with severe dysphagia lasting 6 mo.A barium esophagogram showed that the lower esophagus was compressed within approximately 5.5 cm.Endoscopy revealed the presence of a large submucosal protuberant lesion in the esophagus at a distance of 32-38 cm from the incisors.Endoscopic ultrasound findings demonstrated a 4.5 cm×5.0 cm hypoechoic lesion.Chest computed tomography revealed a mass of size approximately 53 mm×39 mm×50 mm.Initial tests revealed features indicative of leiomyoma.After multidisciplinary discussions,the patient underwent a video-assisted thoracoscopic partial esophagectomy.Further investigation involving immunohistochemical examination confirming palisading spindle cells as positive for S100 and Sox10 led to the final diagnosis of a lower esophageal schwannoma.There was no tumor recurrence or metastasis during follow-up.CONCLUSION The final diagnosis of esophageal schwannoma requires histopathological and immunohistochemical examination.The early appropriate surgery favors a remarkable prognosis.

Removal of esophageal benign tumors with gastroscope-assisted thoracoscopic surgery

The purpose of the study was to report our experience in the treatment of benign esophageal tu- mors with fiberoptic gastroscope-assisted thoracoscopic surgery. Methods： We retrospectively analyzed the clinical data of 24 consecutive patients （22 with esophageal leiomyoma and 2 with esophageal mesenchymoma） who underwent gas-troscope-assisted thoracoscopic surgery. There were 17 male and 7 female with a mean age of 36 years. The tumors were located in the upper and middle part of the esophagus in 17 cases and lower part in 7 cases. Results： All 24 procedures were successfully performed. The median operative time was 84 minutes and the median hospital stay was 7.5 days. One esophageal perforation due to dissection of a large lesion occurred intraoperatively, which was repaired by suturing. No deaths or other severe postoperative complications were encountered during the median follow-up period of 20.5 months. Conclusion： Gastroscope-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of benign esophageal tumors.