Current management of esophageal leiomyoma

Morgagni first described leiomyoma as a distinct gastrointestinal neoplasm in 1761, but Munro in 1797 was the first to report a localized intramural leiomyoma of the esophagus. Much of what is known today about the histologic features of esophageal leiomyoma was specified by Virchow in 1863. Sauerbruch reported the first successful surgical treatment of esophageal leiomyoma when he performed an esophageal resection with gastroesophagostomy in 1932. One year later Ohsawa performed the first successful surgical enucleation of this type of tumor. Leiomyoma has traditionally been classified along with leiomyosarcoma as smooth-muscle–cell tumors. Several years ago the term gastrointestinal stromal tumor (GIST) was introduced as a histogenetically neutral term to refer to all mesenchymal tumors of the GI tract, including those of smooth-muscle–cell origin; but recent evidence indicates that most GISTs comprise a group of neoplasms distinct from true leiomyoma and leiomyosarcoma based on immunohistochemical, ultrastructural, and molecular genetic markers. Pathologists currently classify leiomyoma and GIST as two separate discrete types of tumors. Leiomyoma is the most common mesenchymal tumor of the esophagus but is exceedingly rare in other parts of the GI tract. In contrast GISTs are common in the stomach and intestines but are rarely found in the esophagus. Our objective in preparing this article was to report the currently available techniques for the diagnosis and treatment of esophageal leiomyoma. We have reviewed the English-language literature reporting the various diagnostic and treatment modalities of this condition published between 1900 and 2003. Literature searches were performed on Medline using the following search terms: leiomyoma, esophagus, esophageal mesenchymal tumor, gastrointestinal stromal tumor, and esophageal smooth-muscle tumor.