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Multiple Esophageal Leiomyomas

Rahhal, Riad MD*; Ellison, Jason MD; Bishop, Warren MD*

Journal of Pediatric Gastroenterology & Nutrition: July 2009 - Volume 49 - Issue 1 - p 1
doi: 10.1097/MPG.0b013e3181a70f4d
Image of the Month

*University of Iowa, Iowa City, IA, USA

Idaho Pediatric Gastroenterology, Boise, ID, USA

Address correspondence and reprint requests to Riad Rahhal, MD, University of Iowa Healthcare, Department of Pediatrics 2868JPP, 200 Hawkins Dr, Iowa City, IA 52242, USA (e-mail:

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

An 18-year-old male with profound developmental delay was evaluated for recurrent vomiting. Acid suppression therapy did not alleviate his symptoms. An upper endoscopy showed 5 polypoid lesions in the mid- and upper esophagus (Fig. 1). Cold biopsies showed stratified squamous epithelium with submucosal bland spindled cell proliferation (Fig. 2). Smooth muscle myosin staining was positive (Fig. 3). These findings were diagnostic of esophageal leiomoymas.

Leiomyomas are the most common benign esophageal tumors usually affecting the distal two thirds of the esophagus. In 5% of patients, they can be multiple (1). This should be differentiated from leiomyomatosis, which is characterized by diffuse hypertrophy of the muscular layer (2). Although a leiomyoma is the most likely etiology of an esophageal polypoid lesion in a child, other diagnoses are possible that rarely include malignancy, so histological evaluation is often recommended (3,4).

Esophageal leiomyomas are rarely symptomatic when small (<5 cm in diameter). Large tumors can present with dysphagia, chest pain, obstruction, regurgitation, and, rarely, bleeding. Histologically, leiomyomas are composed of bundles of interlacing smooth muscle cells with a connective tissue capsule covered by mucosa (5).

Asymptomatic or small lesions can be followed periodically as they have a slow growth rate and negligible risk of malignant transformation. Surgical excision is recommended for symptomatic leiomyomas and those >5 cm (1).

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© 2009 Lippincott Williams & Wilkins, Inc.