Esophageal Leiomyoma Presenting as Calcified Esophageal Mass

A 57-year-old man with history of gastroesophageal reflux disease and Barrett’s esophagus, for which he was taking pantoprazole, complained of persistent post-prandial cough. Exam was unremarkable. A chest x-ray showed a 4 x 5 x 5-cm retrocardiac ovoid smoothly marginated soft tissue opacity. A computed tomography (CT) scan of the chest with contrast showed a hiatal hernia with a rounded mass containing multiple calcifications and projecting into the lumen (Figure 1). Esophagogastroduodenoscopy (EGD) showed a subtle submucosal bulging within a hiatal hernia sac, and endoscopic ultrasound (EUS) revealed a densely calcified hypoechoic mass that appeared to arise from muscularis propria (Figure 2). A laparoscopic robotic distal paraesophageal mass excision with esophagomyotomy repair was performed. On pathological exam, the mass was consistent with leiomyoma with degenerative changes (Figure 3). Smooth muscle actin immunohistochemistry showed diffuse cytoplasmic reactivity (Figure 4). Immunohistochemistry for S-100 protein and c-Kit were negative, ruling out nerve sheath tumor and gastrointestinal stromal tumor (GIST), respectively. Postoperatively he was discharged home uneventfully.