Leiomyoma

• Most common benign Mesenchymal tumours of oesophagus
  • M > F 2:1
  • Typically distal or middle 1/3
• Arise in muscularis propria
  • Most < 3cm
• Most asymptomatic
  • If larger can cause dysphagia
• Form hard white/greyish mass
• Shows smooth filling defect on barium swallow
• Similar round, smooth defect with overlying normal mucosa on OGD
• EUS shows regular bordered, hypoechoic lesions arising from muscularis
• Can manage small (< 2cm), classically appearing lesions conservatively unless symptomatic
  • Enucleate if uncertain or symptomatic
    • NB: Biopsy = Harder to enucleate!
• Immunostains for Desmin and Smooth Muscle Actin
  • Differentiates from GIST
    • Stains for KIT and DOG1
• DDX Leiomyosarcoma, GIST