Clinical Endoscopy

Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study: Sun Moon Kim, Eun Young Kim, Jin Woong Cho, Seong Woo Jeon, Ji Hyun Kim, Tae Hyeon Kim, Jeong Seop Moon, Jin-Oh Kim, the Research Group for Endoscopic Ultrasound of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2021;54(6):872-880. Published online November 18, 2021; DOI: https://doi.org/10.5946/ce.2021.251

Background
/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods
We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results
Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions
The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

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Superficial Esophageal Neoplasms Overlying Leiomyomas Removed by Endoscopic Submucosal Dissection: Case Reports and Review of the Literature: Myeongsook Seo, Do Hoon Kim, Young-Whan Cho, Eun Jeong Gong, Sunpyo Lee, Eunji Choi, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2015;48(4):322-327. Published online July 24, 2015; DOI: https://doi.org/10.5946/ce.2015.48.4.322

Abstract PDF PubReader ePub

The coexistence of an epithelial lesion and a subepithelial lesion is uncommon. In almost all such cases, the coexistence of these lesions appears to be incidental. It is also extremely rare to encounter a neoplasm in the surface epithelium that overlies a benign mesenchymal tumor in the esophagus. Several cases of a coexisting esophageal neoplasm overlying a leiomyoma that is treated endoscopically or surgically have been reported previously. Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.

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Leiomyomatosis of the esophagus and rectum in a 16-year-old patient
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Russian Journal of Pediatric Surgery.2022; 26(2): 122. CrossRef
Esophageal low-grade intraepithelial neoplasia overlying multiple leiomyomas: A case report and review of the literature
Wen Pan, Junchao Wu, Chao Liu, Yanjun He, Jinlin Yang
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Rectal Leiomyoma Diagnosed by Endoscopic Ultrasonography and Endoscopic Polypectomy: Sung Whan Cho, M.D., Hyung Yook Kim, M.D.* and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2009;38(3):151-155. Published online March 30, 2009

Abstract PDF: Leiomyoma of the rectum is a rare tumor and it usually present in 40 to 60 year-old individuals, and it is more frequent in men. It originates from either the muscularis mucosa or muscularis externa and those arising from the muscularis mucosa are typically small and they are identified incidentally in patients who are undergoing sigmoidoscopy. In contrast, the larger leiomyomas arising from the muscularis externa generally present symptoms that are consistent with rectal stenosis or a rectal mass. Endoscopic ultrasonography can help to define the tumor location, extension and size. Surgical resection is the treatment for most leiomyomas of the rectum, but endoscopic electroexcision is a safe and appropriate treatment for small polypoid rectal leiomyoma. We report here on a case of a semipedunculated rectal leiomyoma in a 59 year-old female patient. It was found incidentally during a colonoscopic examination and it was diagnosed by endoscopic ultrasonography. We performed endoscopic mucosal resection with colonoscopic snare electrocoagulation. (Korean J Gastrointest Endosc 2009;38:151-155)

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Endoscopic Resection of a Pedunculated Colonic Leiomyoma Resembling a Hyperplastic Polyp: Yong Wan Park, M.D., Young Seok Cho, M.D., Jin Soo Kim, M.D., Hye Sook Son, M.D., Hyung Keun Kim, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2008;37(3):218-221. Published online September 30, 2008

Abstract PDF: Colonic leiomyoma is a rare condition that accounts for 3% of all gastrointestinal leiomyomas. Many colonic leiomyomas are found incidentally and are sometimes confused with epithelial neoplasms. Most leiomyomas are removed surgically. However, a small peduculated leiomyoma can be removed endoscopically as it has the appearance of an adenomatous polyp. A 54 year-old man underwent a colonoscopic examination due to frequent loose stools. Colonoscopy demonstrated the presence of a small reddish polyp with a short stalk in the sigmoid colon. We performed a successful polypectomy by the use of colonoscopic snare electrocauterization. A pathological examination revealed the presence of a leiomyoma originating in the muscularis mucosa. We report a case of a small peduculated leiomyoma that was removed endoscopically, with a review of the literature. (Korean J Gastrointest Endosc 2008;37:218-221)

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A Case of a False Positive FDG-PET/CT Scan in Esophageal Leiomyoma: Eun Ju Song, M.D., Seong Hwan Kim, M.D., Myong Ha Lee, M.D., Sang Ryul Lee, M.D., Sung Hyuk Lee, M.D., Dae Won Jun, M.D., Moon Hee Song, M.D., Yun Ju Jo, M.D., Young Sook Park, M.D. and Boo Whan Hong, M.D.*; Korean J Gastrointest Endosc 2008;36(6):371-375. Published online June 30, 2008

Abstract PDF: Esophageal leiomyoma is relatively rare disease, but can appears with a high uptake of fluorodeoxuglucose (FDG), a false-positive finding on a FDG PET/CT scan. A 64- year-old woman after a total thyroidectomy due to papillary and follicular carcinoma showed a high uptake of FDG in the distal esophagus on a subsequent FDG PET/ CT scan. The presence of an esophageal leiomyoma was suspicious from preoperative findings of endoscopic ultrasound and computed tomography, and an esophagectomy and proximal gastrectomy were performed, as the presence of a malignant lesion could not be excluded. As high uptake of FDG in the lesion on an FDG PET/CT scan corresponds to an esophageal cancer, an esophagectomy and proximal gastrectomy were performed and the lesion was confirmed as an esophageal leiomyoma after surgical biopsies. We report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2008;36:371-375)

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The Endoscopic Ultrasonographic Survey of Benign Mesenchymal Tumor in Upper Gastrointestinal Tract: Soo Jung Lee, M.D., Jin Oh Kim, M.D., Soo Hoon Eun, M.D., Ik Sung Choi, M.D., In Seop Jung, M.D., Bong Min Ko, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., So Young Jin, M.D., Chan Sup Shim; Korean J Gastrointest Endosc 2007;35(3):140-145. Published online September 30, 2007

Abstract PDF: Background
/Aims: A gastrointestinal mesenchymal tumor contains a leiomyoma and gastrointestinal stromal tumor (GIST). The natural course can vary according to the histology and other characteristics. This study evaluated the natural course of a benign mesenchymal tumor in the upper gastrointestinal tract using endoscopic ultrasonography (EUS). Methods: Submucosal mesenchymal tumors are considered benign according to the following criteria of EUS: 1) the tumor originates from the muscularis mucosa or muscularis propria; 2) is well demarcated, homogenous and hypoechoic; and 3) has a regular surface. In this study, the changes of size, internal echo pattern and marginal regularity were evaluated retrospectively in 26 lesions that all were < 3 cm and were followed up for more than 2 years. Results: The average size of the tumors on EUS was 11.5 mm. The mean follow-up period was 47.4 months. The follow-up EUS revealed no change in echo features in any patient. In only one patient, the size of the tumor increased from 26 to 34 mm without a change in the internal echo or marginal regularity after 24 months. This patient underwent a laparoscopic gastric wedge resection. The pathologic diagnosis was a leiomyoma. Conclusions: Most small submucosal tumors that are compatible with the EUS criteria of a benign GIST/ leiomyoma do not change over a period of 24 months, and the EUS criteria are effective in diagnosing benign GISTs/leiomyomas. A benign GIST/leiomyoma at EUS might be followed up by EUS at an interval of 2 years. (Korean J Gastrointest Endosc 2007;35:140-145)

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A Case of Esophageal Carcinoma Coexisting with Leiomyoma Removed by Endoscopic Resection: So Young Joo, M.D., Wan Sik Lee, M.D., Seon Young Park, M.D., Hyeong Cheon Park, M.D., Sung Beom Cho, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D. and Jong Sun Rew, M.D.; Korean J Gastrointest Endosc 2007;34(6):324-328. Published online June 30, 2007

Abstract PDF: The coexistence of esophageal submucosal tumors and carcinomas is rare and the association between them is still unclear. Here, we report a case of a superficial esophageal carcinoma that developed over an esophageal leiomyoma, which was removed successfully by an endoscopic mucosal resection. A 76-year-old man was admitted for the treatment of an esophageal carcinoma. The endoscopic examination revealed a 1 cm-sized round, flat, elevated lesion located at the 25 cm mark of the endoscopy. Endoscopic ultrasonography revealed the carcinoma to be limited to the mucosal layer. Interestingly, a 1.2 cm sized, hypoechoic, subepithelial mass was present beneath the carcinoma. An endoscopic resection was performed simultaneously using a suction and snaring method with a transparent cap attached to the tip of the endoscope. A histopathology examination revealed a squamous cell carcinoma restricted to the mucosa immediately over the benign leiomyoma arising from the muscularis mucosa. The patient has remained well during 1 year follow-up period and has shown no evidence of recurrence.

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평활근종에 의한 대장중첩증 1예( A Case of Adult Intussusception of the Colon Caused by Leiomyoma ): Korean J Gastrointest Endosc 2000;21(2):654-657. Published online November 30, 1999

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원저 : 식도 위장관 ; 복강경을 이용한 양성 위종양 절제술 ( Original Articles : Esophagus , Stomach $ Intestine ; Laparoscopic Partial Gastric Resection for Benign Gastric Tumors ): Korean J Gastrointest Endosc 1998;18(6):841-846. Published online November 30, 1997

Abstract PDF: Background
/Aims: Since the laparoscopic cholecystectomy has been introduced, minimally invasive techniques have been applied to the management of various intraabdominal lesions. Laparoscopic resection of benign gastric tumor has several advantages compared to open surgery; such as reduced postoperative discomfort, early hospital discharge and less complications. Methods: We performed laparoscopic gastric resection for 6 benign gastric leiomyomas and 3 heterotropic gastric pancreases diagnosed by gastric endoscopy and did endoscopic ultrasonography routinely to find out the exact location of mass and depth of invasion. Results: 1) Male to female ratio was 2: 7 and mean age was 48 years. 2) The masses were located at posterior wall of body in 5 cases, fundus in 2 cases, anterior wall of antrum in 1 case, and enterior wall of body, lesser curvature in 1 case. 3) Resection of benign gastric tumors were readily achieved laparoscopically, aided by disposable stapling instruments. 4) Mean operation time was 120 minutes and mean hospital stay was 5.1 days. Conclusions: The benign gastric tumors can be managed laparoscopically with good results and this procedure provides another choice for the resection of them. (Korean J Gastrointest Endosc 18: 841-846, 1998)

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증례 : 식도 위장관 ; 소아에서 내시경 초음파 검사로 진단된 위 점막하 종양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Submucosal Tumors in Children Diagnosed by Endoscopic Ultrasonography ): Korean J Gastrointest Endosc 1998;18(5):750-754. Published online November 30, 1997

Abstract PDF: Benign neoplasms of the stomach are uncommon in children. They include adenomatous and hyperplastic polpys, leiomyomas, lipomas, and other lesions. Gastric leiomyoma in childhood represent only 1% of all gastrointestinal neoplasms reported, and slightly more than half of these are gastric. The tumor arises in the muscle layer of the stomach and is usually intragastric and submucosal. Barium contrast studies are useful in localizing leiomyoma with significant intramural or submucosal growth. An endoscopy can permit histologic confirmation if the tumor has eroded through the mucosa. Differentiation however, of malignant lesions from benign submucosal leiomyomas may be difficult. Using endoscopic ultrasonund imaging, highly accurate gastrointestinal tumor characterization, especially submucosal masses, and differentiation of malignant from benign lesion are now relatively possible without surgery. We experienced a case of a gastric submucosal tumor regarded as a leiomyoma, which was diagnosed using endoscopic ultrasonography, and report the findings with a review of related literatures. (Korean J Gastrnintest Endosc 18: 750-754, 1998)

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증례 : 식도 위장관 ; 상부위장관 출혈을 동반한 십이지장 평활근종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Leiomyoma Presenting with Upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1997;17(1):59-65. Published online November 30, 1996

Abstract PDF: Leiomyoma is a neoplasm of smooth muscle relatively common in the stomach, but very rare in the duodenal location. Recurrent bouts of severe melana remain the most frequent presenting symptom for leiomyoma. A 69-year-old man presented to us with a 4-day history of melena. Endoscopy revealed norinal mucosa covered ovoid elevated lesion with central linear depression and ulcer at the second portion of duodenum. Endoscopic biopsy showed chronic inflammation only. Duodenal mass was excised through a duodenotomy. Pathological diagnosis was leiomycena. (Korean J Gastrointest Endosc 17: 59-63, 1997)

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증례 : 위의 평활근종에 의해 유발된 위십이지장중첩증 1예 ( Case Reports : A Case of Gastroduodenal Intussusception caused by Gastric Leiomyoma ): Korean J Gastrointest Endosc 1995;15(2):258-265. Published online November 30, 1994

Abstract PDF: Gastroduodenal intussusception is an rare condition usually caused by prolapse of a gastric tumor with subsequent invagination of a portion of the stomach wall into the duodenum. Symptoms are protean, but classically patients have presented with episodic epigastric abdominal distress, a history of intermittent vomiting and gastroduodenal bleeding, either as melena, hematochezia, or stools positive for occult blood. Examination generally discloses a fullness or mass in the epigastrium. Its typical radiologic presentation includes luminal narrowing, distally converging gastric folds, infolding and outpouching of the gastric wall, a filling defect, and a coil-spring pattern. A 71-year-old man was admitted for epigastric pain and melena which required blood transfusions. Endoscopy showed an unexplained pulling-down of part of the gastric body and the pylorus couldn't be identified. An upper GI barium examination demonstrated a huge lobulated mass from the distal antrum of stomach to the duodenal cap. On abdominal sonography, double contour of stomach wall was seen at the proximal portion of narrowing stomach. At surgery, a large, intraluminally exophyting gastric mass prolapsed into duodenum was excised and diagnosed as leiomyoma of stomach.

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증례 : 식도 평활근종 2예 ( Case Reports : Two Cases with Leiomyoma of the Esophagus ): Korean J Gastrointest Endosc 1994;14(4):418-424. Published online November 30, 1993

Abstract PDF: Leiomyoma is the most common benign tumor of the esophagus, but it still occurs rarely as compared with the incidence of carcinoma in this area. Most of leiomyomas may manifest itself with unusual and inconsistent symptoms, and found incidentally during endoscopic or radiographic examination. Those who menifested symptoms are included as dysphagia and vague pain mostly. We experienced recently two cases with esophageal leiomyoma who underwent successful surgical resection and endoscopic enucleation, respectively.

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위평활근종에 의한 위 천공 1예 ( A Case with Perforated Gastric Leiomyoma ): Korean J Gastrointest Endosc 1993;13(1):61-64. Published online November 30, 1992

Abstract PDF: Gastric leiomyomas, which arise from smooth muscle tissue, are the most common non-epi- thelial tumors occurring in the stomach. This tumor is most commonly found incidentally at surgery or autopsy. The incidence of the leiomyoma is about 1-3% of all gastric tumors and sex distribution is equal. We have recently experienced a 59-year-old housewife who had epigastric pain and soreness of one month's duration. Physical examination disclosed tenderness with palpated mass in the left upper quadrant. Gastrofiberscopic finding revealed esophageal diverticulum in the mid-esophagus and 2 x 2 x 1 cm sized submucosal intramural mass with centrally depressed umbilication through ulcerative change on the greater curvature of lower body. Within the umbilication, there were food materials and blood clots. The sleeve segmental resection of stomach was performed. The histopathologic and post operative findings were atypical leiomyoma, perforated with abscess formation to the omentum.

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