V-18. Giant Esophageal Leiomyoma Occupying the Left Hemithorax: Surgical Strategy Challenges in a Case With Hyaline Degeneration and Calcification

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ID: 325955
2026
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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Esophageal leiomyomas are rare benign mesenchymal tumors arising from the muscularis propria and represent the most common benign tumors of the esophagus. They usually grow slowly and may remain asymptomatic for long periods. When large, they can cause progressive dysphagia and compressive symptoms, posing diagnostic and therapeutic challenges. Methods Case Presentation A 41-year-old woman with no significant comorbidities presented with a 5-year history of progressive dysphagia, initially tolerating solid food and later progressing to liquid-only intake. She also reported regurgitation and epigastric pain, without weight loss. In April 2025, she developed thoracic spine pain, prompting further investigation. Physical examination revealed a patient in good general condition, with normal vital signs and a body mass index of 20 kg/m2. Abdominal examination was unremarkable. Imaging and Diagnostic Workup Initial contrast-enhanced chest computed tomography revealed a large mediastinal mass suspicious for esophageal origin. Further evaluation with abdominal magnetic resonance imaging demonstrated a well-defined solid lesion with areas of degeneration and calcification. Endoscopic ultrasound showed a hypoechoic mass originating from the muscularis propria of the esophagus. Fine-needle aspiration biopsy was inconclusive, and malignancy could not be definitively excluded. Results The patient underwent a thoracoscopic esophagectomy with abdominal and cervical approaches, indicated by the lesion's size, symptoms, and diagnostic uncertainty. Complete en bloc tumor resection, occupying a significant portion of the left hemithorax, was achieved via laparotomy with diaphragm opening, posing a surgical challenge. Despite esophageal cardia infiltration by the giant leiomyoma, reconstruction was performed using a gastric conduit after proximal gastrectomy, completing the esophagectomy. Gross examination revealed a well-circumscribed intramural esophageal mass. Histopathological analysis confirmed a leiomyoma arising from the muscularis propria, with extensive hyaline degeneration and focal calcifications. Immunohistochemical staining showed positivity for smooth muscle markers (α-smooth muscle actin, desmin) and negativity for CD34, c-KIT (CD117), DOG-1, S100, and Ki-67, confirming benign leiomyoma and excluding GISTs/other mesenchymal neoplasms. Surgical margins were tumor-free. Uneventful post-operative evaluation occurred. Extubated Day 1. Oral diet Day 7 after no leak. Discharged Day 10. Patient remained asymptomatic, tolerating diet well at follow-up. Conclusion This case highlights a rare presentation of a giant esophageal leiomyoma with hyaline degeneration and calcification, causing long-standing progressive dysphagia. Complete surgical resection remains the treatment of choice for large or symptomatic lesions, especially when malignancy cannot be ruled out preoperatively. Multimodal imaging and immunohistochemical analysis are essential for accurate diagnosis and appropriate management. Video Description The video presents the thoracic phase of the esophagectomy, highlighting the challenges in resecting the giant lesion that extended from the esophagus above the azygos arch to the diaphragmatic region. The video demonstrates the right thoracoscopic approach, which will be complemented by a median laparotomy with transection of the left diaphragm for tumor resection and access to the left hemithorax.
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Authors Francisco Carlos Bernal da Costa Seguro, Sérgio Szachnowicz, Rodrigo Nicida Garcia, Fernando D Almeida Perazzo, Juan David Perez, Rubens Antônio Aissar Sallum, Ulysses jr Ribeiro, Paulo Herman
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.418
URL
https://doi.org/10.1093/dote/doag077.418
Keywords Keywords not found

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