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case_images: Esophagogastroduodenoscopy (EGD) and endoscopic ultrasonography (EUS) demonstrated esophageal mucosal and submucosal lesions. (A) The submucosal eminences were observed in the right posterior wall and the left anterior wall of esophagus. (B, C) Multiple shallow red depressions were observed on the right posterior wall surface. The mucosa background color was noticed by NBI, while the dilated and tortuous vessels on the top of the lesion were observed by NBI near focus. (D) EUS showed uniform hypoechoic inside, irregularly shaped, clear-boundary esophageal multiple hypoechoic mass, which originated from the mucosal muscle layer.
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case_images: Multiple redness and shallow depressions were discovered on the right posterior wall surface additionally ( Figure 1A ). We noticed the mucosa of the right wall with brown background color by using narrow-band imaging (NBI) ( Figure 1B ). Meanwhile, the dilated and tortuous intrapapillary capillary loops with homogeneous distribution and increased density were displayed in the mucosa of the right wall under NBI-near focus ( Figure 1C ). The largest one had an ultrasonic diameter of about 9.9x6.9 mm ( Figure 1D ).
case_images: Enhanced chest CT. Enhanced chest CT showed that the wall of the upper and middle segments of the esophagus was slightly thickened and the lumen slightly narrowed.
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case_images: Postoperative endoscopic manifestations. (A) The right posterior wall lesion was completely resected without intraoperative complications. (B) Follow-up gastroscopy displayed white scars on the right lateral wall of the upper esophagus.
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case_images: Follow-up EGD noticed white scars on the right wall of the upper esophagus ( Figure 3B ), while there was a longitudinal submucosal eminence (18-21 cm away from the incisor) at the left wall, which showed a light brown color change without confirmed demarcation line under NBI.
case_images: Histopathology for ESD specimen. (A) Gross specimen after ESD in vitro. (B-D) Coexistence of submucosal spindle cell neoplasm and focal squamous LGIN in HE staining (*10, 40, 100). (E) Ki76 showed LGIN. (F) Desmin staining displayed leiomyoma. (G) SMA staining displayed leiomyoma.
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case_images: We observed the gross specimens after iodine staining and noticed unstained or lightly stained area located mainly at the top of the eminence ( Figure 4A ), which may be related to long-term friction and chronic inflammation. Pathological examination demonstrated submucosal spindle cell tumor with focal squamous epithelium LGIN in the esophagus through hematoxylin-eosin (HE), and finally diagnosed as submucosal leiomyoma with focal LGIN by immunohistochemistry staining ( Table 1  and  Figures 4B-G ).