A leiomyoma is a benign, smooth muscle tumor. It may also be called a fibroid. Leiomyoma is very rare, accounting for less than 1% of esophageal tumors.

Symptoms of Leiomyoma

Leiomyomas rarely cause symptoms when they are smaller than 5 cm. in diameter. When they grow larger, they may mimic the symptoms of esophageal cancer and cause similar symptoms, including:

• Difficulty swallowing (dysphagia)
• Chest pain
• Food regurgitation (backup)
• Regurgitation

Causes of Leiomyoma

A leiomyoma is generally a benign tumor that arises from the smooth muscle of esophagus. It is rare that it becomes malignant.

Diagnosing Leiomyoma

Testing for leiomyoma may include:

• Barium swallow uses barium to monitor movement through your esophagus, stomach and small intestine.
• Upper GI endoscopy uses an endoscope to see inside your upper GI tract to determine if you have any changes in its lining.
• Endoscopic ultrasound
• CT scan imaging method that uses X-rays to create pictures of cross-sections of your body.

Treating Leiomyoma

Tumor size and location are important when discussing treatment with your physician as well as any other health problems you may be experiencing. 

If your leiomyoma is small and not expected to be malignant, you may be advised to take a wait and watch approach that includes regular barium swallows and endoscopy to help monitor your condition.

Asymptomatic or smaller lesions (less that 5 cm) should be followed closely because they can continue to grow slowly. An argument can be made, however, that all leiomyomas should be removed as there is a low risk of developing malignancy.

Resection is recommended for symptomatic lesions and those that are 5 cm or larger.

If surgical treatment is needed, it may include: 

• Surgical resection: removal or enucleation of the leiomyoma. Enucleation is when the esophagus muscle is gently opened longitudinally in order to reveal the lesion. Careful dissection is performed to separate and remove the leiomyoma from the underlying submucosa, which is a tissue layer of the esophagus. This can be performed through a minimally invasive procedure (VATS), thorascopically or robotically.   
  • Video-assisted thoracoscopic surgery (VATS) – minimally invasive surgery that uses a camera inserted into your chest through small incisions to allow your thoracic surgeon to see inside your chest without requiring a larger incision.