Rare case of giant upper oesophageal leiomyoma

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A Giant Upper Esophageal Leiomyoma
Frontal and lateral chest radiograph shows a large superior posterior mediastinal mass.
  • Benign oesophageal tumours, for example, leiomyoma are very rare and represent only 10% of oesophageal tumours.
  • However, despite its rarity, it is the most common oesophageal tumour.
  • This article highlights the case of a 55-year-old woman diagnosed with an oesophageal leiomyoma.

A 55-year-old woman presented with a 3-month history of productive cough with yellow sputum. However, without any blood. According to the patient, there were no aggravating or relieving factors of the cough. She used over-the-counter medications for symptomatic relief, but there were no signs of improvement. The patient was otherwise healthy and had no history of respiratory disease, asthma or allergies. She had no recent travel history, did not smoke or drink alcohol. Her family and social history were also unremarkable. The patient was given the diagnosis of a giant upper oesophageal leiomyoma.

Examination showed normal vitals. Whereas chest examination was consistent with the presence of bilateral vesicular breathing sound in the absence of crepitation. Similarly, auscultation of the precordium showed normal heart sounds. Doctors further advised basic laboratory tests, including renal and hepatic profiles, findings of which were within normal range. Plain chest radiograph showed a well-defined oval-shaped soft tissue mass in the superior mediastinum. This further caused a narrow displacement of the trachea. Stripped calcifications were also evident within the mass.

Diagnosis: upper oesophageal leiomyoma

An upper gastrointestinal study showed a marked deviation of the upper thoracic oesophagus. However, the narrowing caused was minimal. CT scan confirmed the presence of a large soft tissue mass in the posterior superior mediastinum, arising from the oesophagus and extending from the level of C7 to T5. The trachea, including major vessels were also displaced anteriorly. The stippled calcifications within the lesion were suggestive of the diagnosis of leiomyoma.

Based on the clinical and laboratory findings, the patient was advised an Ivor Lewis procedure for resection of the oesophagus. The patient had an uneventful recovery. Histopathological examination of the lesion further confirmed the diagnosis of an oesophageal leiomyoma. The patient was discharged on the 5th day after the surgery. In follow-up visits, a complete resolution of symptoms was seen. However, she developed a new symptoms of hoarseness, consistent with left vocal cord palsy. Doctors referred her for speech-language therapy.

Source: American Journal of Case Reports

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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