Skip to main content
SpringerLink
Log in

Esophageal squamous cell carcinoma or high-grade dysplasia overlying leiomyoma, rare but not to be neglected

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

Esophageal squamous cell carcinoma (ESCC) and leiomyoma are common tumors. The coexistence of these two tumors can be classified into two types: the overlying type and the separate type. The overlying type is rare.

Methods

We report 12 cases of the overlying type treated by endoscopic submucosal dissection (ESD). They underwent pre-ESD endoscopic examination with white-light imaging, iodine staining, narrow-band imaging, endoscopic ultrasound, and biopsy. The clinical, endoscopic and pathologic characteristics were reviewed.

Results

Among the 12 patients, 3 were female and 9 were male. The age range was 49–76 years. They accounted for 4.0% of 300 cases of esophageal leiomyoma and 1.3% of 955 cases of superficial ESCC or high-grade dysplasia treated by endoscopic resection. After endoscopic examination and biopsy, ESCC or high-grade dysplasia, combined with leiomyoma was considered in four cases; leiomyoma was considered but without the squamous lesion (underdiagnosis) in another case; and leiomyoma was mistaken for submucosal ESCC (overdiagnosis) in the other seven cases. ESD specimens showed that nine cases were intramucosal or submucosal ESCC, and three cases were high-grade dysplasia, overlying leiomyoma originating from the muscularis mucosae or muscularis propria. The 12 cases were successfully treated by ESD, with no recurrence during follow-up.

Conclusions

We must keep in mind that ESCC or high-grade dysplasia can occur overlying leiomyoma. These cases are rare but should not be neglected, especially in high-risk areas for ESCC. These patients can receive appropriate treatment if overdiagnosis or underdiagnosis can be avoided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Postlethwait RW, Musser AW. Changes in the esophagus in 1,000 autopsy specimens. J Thorac Cardiovasc Surg. 1974;68(6):953–6.

    Article  CAS  PubMed  Google Scholar 

  2. Mutrie CJ, Donahue DM, Wain JC, et al. Esophageal leiomyoma: a 40-year experience. Ann Thorac Surg. 2005;79(4):1122–5.

    Article  PubMed  Google Scholar 

  3. Takubo K, Nakagawa H, Tsuchiya S, et al. Seedling leiomyoma of the esophagus and esophagogastric junction zone. Hum Pathol. 1981;12(11):1006–10.

    Article  CAS  PubMed  Google Scholar 

  4. Callanan JG. Simultaneous occurrence of simple and malignant tumors in the esophagus. J Thorac Surg. 1954;28(1):4–10.

    Article  CAS  PubMed  Google Scholar 

  5. Lu YK, Li YM, Keng CC. The coexistence of benign and malignant tumors of the esophagus. Chin Med J. 1963;82:805–8.

    CAS  PubMed  Google Scholar 

  6. Seo M, Kim DH, Cho YW, et al. Superficial esophageal neoplasms overlying leiomyomas removed by endoscopic submucosal dissection: case reports and review of the literature. Clin Endosc. 2015;48(4):322–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Qin X, He S, Zhang Y, et al. Diagnosis and staging of superficial esophageal precursor based on pre-endoscopic resection system comparable to endoscopic resection. BMC Cancer. 2014;14:774.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wang GQ, Wei WQ, Lu N, et al. Significance of screening by iodine staining of endoscopic examination in the area of high incidence of esophageal carcinoma. Ai Zheng. 2003;22(2):175–7.

    PubMed  Google Scholar 

  9. Muto M, Horimatsu T, Ezoe Y, et al. Narrow-band imaging of the gastrointestinal tract. J Gastroenterol. 2009;44(1):13–25.

    Article  PubMed  Google Scholar 

  10. Iizuka T, Kato H, Watanabe H, et al. Superficial carcinoma of the esophagus coexisting with esophageal leiomyoma: a case report and review of the Japanese literature. Jpn J Clin Oncol. 1984;14(1):115–22.

    CAS  PubMed  Google Scholar 

  11. Watanabe M, Baba T, Hotchi M. A case of leiomyoma of the lamina muscularis mucosae of the esophagus with a complication of carcinoma in situ of the overlying mucosa. Acta Pathol Jpn. 1987;37(11):1845–51.

    CAS  PubMed  Google Scholar 

  12. Yoshikane H, Tsukamoto Y, Niwa Y, et al. The coexistence of esophageal submucosal tumor and carcinoma. Endoscopy. 1995;27(1):119–23.

    Article  CAS  PubMed  Google Scholar 

  13. Nagashima R, Takeda H, Motoyama T, et al. Coexistence of superficial esophageal carcinoma and leiomyoma: case report of an endoscopic resection. Endoscopy. 1997;29(7):683–4.

    Article  CAS  PubMed  Google Scholar 

  14. Fu KI, Muto M, Mera K, et al. Carcinoma coexisting with esophageal leiomyoma. Gastrointest Endosc. 2002;56(2):272–3.

    Article  PubMed  Google Scholar 

  15. Ishida M, Mochizuki Y, Iwai M, et al. Esophageal squamous cell carcinoma in situ overlying leiomyoma: a case report with review of the literature. Int J Clin Exp Pathol. 2013;6(12):3026–8.

    PubMed  PubMed Central  Google Scholar 

  16. Oh WJ, Lee EJ, Lee YS, et al. Esophageal squamous cell carcinoma in situ overlying leiomyoma mimicking invasive cancer: a brief case report. Korean J Pathol. 2014;48(2):162–3.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sarbia M, Katoh E, Borchard F. Collision tumor of squamous cell carcinoma and leiomyoma in the esophagus. Pathol Res Pract. 1993;189(3):360–2 (discussion 363-4).

    Article  CAS  PubMed  Google Scholar 

  18. Ahn SY, Jeon SW. Endoscopic resection of co-existing severe dysplasia and a small esophageal leiomyoma. World J Gastroenterol. 2013;19(1):137–40.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ishihara R, Yamamoto S, Yamamoto S, et al. Endoscopic resection of the esophageal squamous cell carcinoma overlying leiomyoma. Gastrointest Endosc. 2008;67(4):745–7.

    Article  PubMed  Google Scholar 

  20. Kuwano H, Sadanaga N, Watanabe M, et al. Esophageal squamous cell carcinoma occurring in the surface epithelium over a benign tumor. J Surg Oncol. 1995;59(4):268–72.

    Article  CAS  PubMed  Google Scholar 

  21. Mizobuchi S, Kuge K, Matsumoto Y, et al. Co-existence of early esophageal carcinoma and leiomyoma: a case report. Jpn J Clin Oncol. 2004;34(12):751–4.

    Article  PubMed  Google Scholar 

  22. Iwaya T, Maesawa C, Uesugi N, et al. Coexistence of esophageal superficial carcinoma and multiple leiomyomas: a case report. World J Gastroenterol. 2006;12(28):4588–92.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Niimi K, Kodashima S, Ono S, et al. Curative ESD for intraepithelial esophageal carcinoma with leiomyoma mimicking submucosal invasive carcinoma. World J Gastrointest Endosc. 2009;1(1):68–71.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Geramizadeh B, Ziyaian B, Safari A. Invasion of esophageal leiomyoma by coexistent overlying squamous cell carcinoma. J Gastrointest Cancer. 2009;40(3–4):131–2.

    Article  PubMed  Google Scholar 

  25. Endoscopic Classification Review Group. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37(6):570–8.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Natural Science Foundation of China (No. 81402463), CAMS Initiative for Innovative Medicine (CIFMS) (No. 2016-I2M-1-001 and No. 2016-I2M-3-005) and the National Key R&D Program of China (No. 2016YFC1302800).

Author information

Author notes

  1. Ning Lu

    Present address: Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

  2. Changyuan Guo, Dan Liu, Yong Liu are equal contributors.

Authors and Affiliations

  1. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Changyuan Guo, Dan Liu, Lei Guo, Lulu Rong & Liyan Xue

  2. Department of Pathology, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing, China

    Dan Liu

  3. Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Yong Liu & Guiqi Wang

Authors
  1. Changyuan Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lulu Rong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guiqi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ning Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liyan Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Guiqi Wang, Ning Lu or Liyan Xue.

Ethics declarations

Ethical Statement

The study protocol was approved by the institutional review boards of the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. All procedures were conducted in accordance with the ethical standards of the Helsinki Declaration of 1975. Informed consent was obtained from all study participants at the time of the irst outpatient appointment. Written consent was obtained from the 12 patients for the use of their clinicopathological information for research purposes.

Conflict of interest

The authors declare that they have no COIs regarding this article. If a failure of accurate reporting about COI disclosure is suspected, the matter will be resolved following the procedure detailed in the COPE guidelines.

Informed consent

Written informed consent was obtained from the patients for publication of this case series and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, C., Liu, D., Liu, Y. et al. Esophageal squamous cell carcinoma or high-grade dysplasia overlying leiomyoma, rare but not to be neglected. Esophagus 18, 125–137 (2021). https://doi.org/10.1007/s10388-020-00747-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-020-00747-4

Keywords

Search

Navigation