S1826 Case Series: Successful Endoscopic Resection of Colorectal Leiomyomas

Abstract

Introduction: Colorectal leiomyomas are relatively uncommon, accounting for 3% of all gastrointestinal leiomyomas. Leiomyomas are often identified incidentally; however, some patients may present with symptoms of abdominal pain or rectal bleeding. Surgical resection was historically the standard of care for removal of these smooth muscle tumors, particularly for tumors larger than 2 cm. However, with ongoing advances in endoscopic techniques, endoscopic polypectomies have fallen into favor for management of these submucosal lesions as it is less invasive and less costly. We present two cases of colorectal leiomyomas that were successfully managed endoscopically without surgical intervention. Case Description/Methods: A 69-year-old male presented to the gastroenterology clinic for colorectal cancer screening. He endorsed 3 to 4 bouts of watery diarrhea daily and 15-pound unintentional weight loss over one year duration. A colonoscopy was subsequently performed revealing a 1cm pedunculated polyp in the descending colon [See Figure 1]. The base of the polyp was injected with 4mL of 1:100,000 epinephrine with adequate lift. A hot snare polypectomy was performed using standard ERBE settings. Pathology revealed a submucosal benign mesenchymal neoplasm. Immunohistochemical staining was strongly positive for Smooth Muscle Actin (SMA) and Desmin, solidifying the diagnosis of leiomyoma. A 41-year-old male was seen by the gastroenterology division on the inpatient service for evaluation of rectal bleeding. A colonoscopy was performed revealing a 4mm sessile polyp in the rectum that was completely removed via cold biopsy forceps [See Figure 2]. Pathology revealed a microscopic submucosal spindle cell lesion. Immunohistochemical staining was positive for SMA with no expression of CD-117 and DOG-1, supporting the diagnosis of leiomyoma. Discussion: The optimal therapeutic approach for large colorectal leiomyomas remains controversial but usually depends on the location, size, and direction of tumor growth. Our patients were managed successfully with endoscopic resection alone. Both patients had a surveillance colonoscopy that revealed no residual tumor or recurrence of tumor growth. These benign smooth muscle tumors have excellent prognosis and typically do not recur after removal. These cases support the notion that leiomyomas can often be removed endoscopically with limited morbidity and have excellent outcomes.Figure 1.: 1 cm pedunculated polyp in descending colon (case 1).Figure 2.: 4 mm sessile polyp in rectum (case 2).