Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 28, 2006; 12(28): 4588-4592
Published online Jul 28, 2006. doi: 10.3748/wjg.v12.i28.4588
Coexistence of esophageal superficial carcinoma and multiple leiomyomas: A case report
Takeshi Iwaya, Chihaya Maesawa, Noriyuki Uesugi, Toshimoto Kimura, Kenichiro Ikeda, Yusuke Kimura, Shingo Mitomo, Kaoru Ishida, Nobuhiro Sato, Go Wakabayashi
Takeshi Iwaya, Kenichiro Ikeda, Yusuke Kimura, Shingo Mitomo, Kaoru Ishida, Go Wakabayashi, Departments of Surgery I, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan
Chihaya Maesawa, Toshimoto Kimura, Departments of Pathology, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan
Noriyuki Uesugi, Division of Pathology, Central Clinical Laboratory, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan
Nobuhiro Sato, Critical Care Medicine, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan
Correspondence to: Takeshi Iwaya, MD, PhD, Department of Surgery I, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan. tiwaya@iwate-med.ac.jp
Telephone: +81-19-6515111 Fax: +81-19-6517166
Received: January 25, 2006
Revised: March 1, 2006
Accepted: April 21, 2006
Published online: July 28, 2006
Abstract

Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-year-old man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient’s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas (20 lesions, up to 3 cm in diameter), and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be misdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.

Keywords: Multiple leiomyomas; Squamous cell carcinoma; Esophagus; Coexistence