case_images: PMC8315862_01
case_images: The esophageal ulcer just above the gastroesophageal junction and hiatal hernia detected during the first upper astrointestinal endoscopy (UGIE) (a, b). The ulcer had completely healed after 10-week treatment with double-dose proton pump inhibitor. A protrusion at the cardia, which was only identified on the look down view with minimum insufflated air, suspecting submucosal lesion is shown (c, d). The UGIE performed four months after her surgery demonstrated good results of Nissen fundoplication (e, f).
case_images: CRIM2021-9925224.001.jpg
case_images: PMC8315862_01_CRIM2021-9925224.001.jpg
case_images: fig1
case_images: The upper gastrointestinal endoscopy (UGIE) performed at another hospital showed a lower esophageal ulcer, which was located just above the gastroesophageal junction, hiatal hernia, and antral-predominant gastritis (Figures 1(a) and 1(b)). The second UGIE performed when the patient was still on PPI showed that the lower esophageal ulcer had completely healed (Figures 1(c) and 1(d)). Four months after her surgery, UGIE was performed again which showed good results of fundoplication surgery (Figures 1(e) and 1(f)).
case_images: Endoscopic ultrasound showed that the submucosal tumor arose from the fourth layer of the esophageal wall (a, b). EUS-FNA was performed (c). The histological findings on hematoxylin and eosin staining (d) and immunohistochemical stainings with Desmin (+) and Ki67 (+) confirmed that the tumor was a leiomyoma.
case_images: CRIM2021-9925224.002.jpg
case_images: PMC8315862_01_CRIM2021-9925224.002.jpg
case_images: fig2
case_images: Endoscopic ultrasound (EUS) and CT scan were performed which surprisingly showed a giant submucosal tumor at the fourth layer of the lower esophagus and the cardia (Figures 2 and 3). EUS-FNA was performed, and the histological examination confirmed that this lesion was a leiomyoma (Figure 2).
case_images: Uneven thickening of the distal esophagus and cardia on the CT scan, measuring about 8 cm in length and 3.5 cm in diameter. The asterisks mark the tumor mass.
case_images: CRIM2021-9925224.003.jpg
case_images: PMC8315862_01_CRIM2021-9925224.003.jpg
case_images: fig3
case_images: Endoscopic ultrasound (EUS) and CT scan were performed which surprisingly showed a giant submucosal tumor at the fourth layer of the lower esophagus and the cardia (Figures 2 and 3).
case_images: The distal esophagus evolving leiomyoma was mobilized from the mediastinal pleura and structures (a, b). The leiomyoma was carefully dissected out of the esophagus (c). The tumor had been completely removed (d). Nissen fundoplication was performed (e). The postoperation specimen is shown (f).
case_images: CRIM2021-9925224.004.jpg
case_images: PMC8315862_01_CRIM2021-9925224.004.jpg
case_images: fig4
case_images: In addition, hiatal hernia was repaired with laparoscopic Nissen fundoplication (Figure 4). The solid straightened tumor was approximately 8 cm x 3 cm in size (Figure 4).