Leiomyosarcoma of the esophagus: radiographic findings in 10 patients

Leiomyosarcomas of the esophagus are rare malignant smooth-muscle tumors that have been described only anecdotally in the radiology literature. The objective of this study was to evaluate the clinical and radiographic findings of this unusual lesion. A search of the radiology archives of the Armed Forces Institute of Pathology revealed 10 cases of esophageal leiomyosarcomas. Clinical and radiographic findings were reviewed retrospectively. All but one patient presented with dysphagia. The average duration of the dysphagia was 6.7 months, but five patients had dysphagia for 3 or fewer months. Frontal chest radiographs revealed a mediastinal mass in five patients. Barium studies revealed intramural lesions in six patients, intraluminal lesions in two, and infiltrative lesions in two. The intramural Lesions all had large exophytic components, and three contained ulceration or tracking. One of the intraluminal lesions appeared as a polypoid expansile mass and the other, as a smooth expansile sausage-shaped mass mimicking a fibrovascular polyp. CT revealed a mass involving the esophagus in five patients; three of these patients had heterogeneous lesions containing large exophytic components, central areas of low density, and extraluminal gas or contrast material within the tumor. In two patients, MR imaging revealed large masses that were isointense with skeletal muscle on T1-weighted images and hyperintense on T2-weighted images. Our experience suggests that esophageal leiomyosarcomas have radiographic findings similar to those of leiomyosarcomas elsewhere in the gastrointestinal tract. Esophageal leiomyosarcomas have a better prognosis than squamous cell carcinomas and are often amenable to surgical cure.