Unusual Growth Pattern Research Articles

Abstract A94: Epigallocatechin-3-gallate inhibits stem-like inflammatory breast cancer cells

Abstract Inflammatory Breast Cancer (IBC) is a highly aggressive form of cancer characterized by an unusual growth pattern with nests of tumor emboli rather than a solid mass, rapid spread via lymphatic dissemination and high proliferative rates. Multi-modality therapies have improved survival but the outcome still remains poorer for these patients. Given the potent anti-cancer properties of green tea polyphenols, including epigallocatechin-3-gallate (EGCG), here we tested the hypothesis that EGCG inhibits IBC cells. Two IBC cell lines were studied. SUM-149 cells have a triple negative receptor status (ER-, PR-, Her-2-), while SUM-190 cells are ER-, PR- and Her-2 amplified. Doses of EGCG used ranged from 5 μg/ml (10.9 μM) to 160 μg/ml (349.1 μM), depending upon the presence of serum which inactivates the polyphenol. Treatment with 40 μg/ml (87.3 μM) EGCG decreased mRNA expression of genes that promote migration and invasion (RHOC, FN1, CDH1 and VIM), lymphangiogenesis (VEGF-D), proliferation (CCND1), and survival (BCL-XL) in both lines. Consistently, EGCG treatment resulted in decreased invasive phenotype, ability for anchorage independent growth and viability, as judged by Matrigel outgrowth, soft agar colony assays and ATP assays. Substantial apoptosis was detected starting at 80 μg/ml (174.5 μM) and 160 μg/ml (349.1 μM) of EGCG for SUM-149 and SUM-190 cells, respectively. Conditioned media isolated from EGCG-treated IBC cells displayed decreased secretion of the pro-lymphangiogenic factor VEGF-D and reduced ability to promote cultured hTERT-HDLEC lymphatic endothelial cell migration in wound healing assays and tube formation in Matrigel, processes critical for lymphangiogenesis. The poor clinical outcome of IBC patients has been attributed to a stem-like cell compartment, which is characterized by increased aldehyde dehydrogenase (ALDH) activity. The SUM-149, but not the SUM-190, line has been reported to contain such a stem-like compartment. EGCG treatment inhibited SUM-149 cell spheroid formation and decreased the size of pre-formed spheroids, suggesting efficacy on the cancer stem-like cells. ALDH-positive SUM-149 cells were isolated using an ALDEFUOR Fluorescence Activated Cell Sorting-based assay. EGCG treatment of these cells led to a significant dose-dependent decrease in ATP levels. Furthermore, doses of 80 and 160 μg/ml EGCG induced apoptosis, as judged by increased Caspase-3 and -7 activities. ALDH-positive SUM-149 cancer stem-like cells were used in an orthotopic mammary fat pad mouse model (n = 6/ group). After 25 days, palpable tumors were detected in all of the mice. The experimental group was given a 0.1 ml intraperitoneal injection of 16.5 mg/kg EGCG while the control group was injected with vehicle 1X PBS. Treatment was administered five times a week for five weeks and then daily for one last week for a total of 43 days. EGCG significantly reduced the growth of pre-existing tumors derived from ALDH-positive stem-like SUM-149 cells such that at the end of the experiment a 37.7 ± 4.4% decrease in tumor volume was seen in the EGCG-treated vs control groups. RT-PCR and immunoblot analyses revealed substantially reduced expression of VEGF-D RNA and VEGF-D protein within tumor tissues of EGCG-treated vs control animals, which correlated with a trend toward decreased peritumoral lymphatic vessel density. Thus, EGCG has pleiotropic inhibitory effects on IBC cells, including the cancer stem-like cell compartment believed to be responsible for recurrence. Recent clinical trials using various green tea polyphenol preparations have shown efficacy in treatment of prostate cancer and lymphocytic leukemia, and low toxicity. Our studies suggest the use of EGCG or green tea in combination with standard therapeutic modalities for IBC patients warrants further exploration. Citation Format: Nora D. Mineva, K. Eric Paulson, Stephen P. Naber, Amy S. Yee, Gail E. Sonenshein. Epigallocatechin-3-gallate inhibits stem-like inflammatory breast cancer cells. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr A94.

Mesoblastic nephroma in adult: A case with unusual growth pattern

Mesoblastic nephroma (MN) is an uncommon congenital tumor of infancy that rarely occurs in adults. We report a case of cellular MN in a 40-year-old woman. The tumor showed an unusual pattern of growth as an intracystic mass involving the adjacent renal parenchyma. Microscopically, it consisted of spindle cell proliferation with entrapped dilated renal tubules. Cartilaginous islands and numerous atypical mitotic figures were also noted. Spindle-shaped tumor cells show immunoreactivity for vimentin and variable positivity for estrogen and progesterone receptors (ER and PR). Epithelial membrane antigen was positive only in epithelial component. A combination of histological and immunohistochemical findings is useful in the differential diagnosis of cellular MN from other tumors of the kidney with spindle cell component.

Uterine intravenous leiomyomatosis with cardiac extension: Imaging characteristics and literature review

Intravenous leiomyomatosis (IVL), showing unusual growth patterns of uterine leiomyoma, is a rare neoplasm characterized by intravascular proliferation of a histologically benign-looking smooth muscle cell tumor mass, but not invading the tissue. To date, less than 300 cases have been reported and fewer than 100 cases with cardiac involvement. Imaging characteristics of IVL are still not clear so it is usually misdiagnosed before surgery. A 36-year-old woman, who had undergone hysterectomy due to hysteromyoma, presented with shortness of breath after activities. Imaging showed IVL with mass involvement of the left ovarian vein, left renal vein, left external and common iliac vein, as well as within the inferior vena cava (IVC), extending into the right atrium. The operation demonstrated that the mass had no stalk and had well-demarcated borders with the wall of the right atrium and IVC. The patient underwent a one-stage combined multidisciplinary thoraco-abdominal operation under general anesthetic. Subsequently, the pathology report confirmed IVL. IVL should be considered in a female patient presenting with an extensive mass in the right side of the heart. Imaging technology, such as echocardiogram, contrast-enhanced computed tomography and magnetic resonance imaging, can provide important information to reveal the mass, the range and path of the lesion, and relates to the surgical plan decision. Consequently, perfect and exact image examination is very necessary pre-operation.

Seasonal light interception, radiation use efficiency, growth and tuber production of the tuber crop Plectranthus edulis

Plectranthus edulis (Vatke) Agnew (Lamiaceae) is an ancient Ethiopian crop that produces below-ground, edible tubers on stolons. It is grown from seed tuber pieces. There is thus far little quantitative information on dry matter production of this crop and parameters determining growth and yield. The objective of this study was to understand and quantify the growth of P. edulis, and identify the processes determining and limiting yield. Two similar experiments were carried out at two sites (Awassa and Wondogenet in southern Ethiopia) in a split-plot design with five blocks and cultivar (Lofuwa and Chankua) as main factor and sampling date [20 2-weekly sampling dates from 14 to 280 days after planting (DAP)] as split factor. The crop was unknown at the start and showed an unusual growth pattern, for which reasons growth was analysed at a basic level.Maximum tuber weights were achieved 238 DAP in both cultivars and at both sites, and we consider the period up to 238 DAP as the growth period and the remaining time until the last sampling as the period of in situ storage, as is common farmers’ practice. Tuber dry weights at 238 DAP were c. 900–1000gm−2 and tuber dry matter concentrations 19–21%, corresponding to c. 4.5–4.9kgm−2 fresh tuber yield. Two processes limited the dry matter production: radiation interception by the crop and the conversion of the intercepted radiation into dry matter.Only about one third of the incident radiation was intercepted by the green leaves due to late emergence (c. 4 weeks), a slow development of the canopy after emergence until full ground cover was attained (c. 20 weeks), a short period during which ground cover was complete (c. 2 weeks) and a long period of declining ground cover starting 8 weeks before the end of the growing period.The radiation use efficiency (RUE) was established for the crops in Wondogenet and was only 1.59gMJ−1 PAR, on average across sampling dates. RUE varied across the growing period, increasing after emergence until early after tuber formation to about 2.7gMJ−1 PAR, then again decreasing because of a temporary stagnation (cv. Chankua in Awassa) or decrease (all other cultivar×site combinations) in total crop dry weight, starting 168 DAP in Awassa and 182 DAP in Wondogenet and lasting several weeks. During this period crop biomass decreased because the loss in canopy dry matter – especially stem dry matter – was not yet compensated for by an increase in tuber dry matter. Later, tuber production more than outweighed the decrease in canopy dry weight, and total dry weight and RUE increased again. During this last period the green stems might have significantly contributed to crop photosynthesis. The relative allocation of the total dry matter produced to the tuber varied between 81 and 99% at 238 DAP. Keeping the tubers in the soil after 238 DAP reduced tuber dry weights by 37–54% in 6 weeks.

Unusual Southern Hemisphere tree growth patterns induced by changes in the Southern Annular Mode

Recent changes in the summer climate of the Southern Hemisphere extra-tropics are primarily related to the dominance of the positive phase of the Southern Annular Mode1, 2. This shift in the behaviour of the Southern Annular Mode—essentially a measure of the pressure gradient between Southern Hemisphere mid and high latitudes—has been predominantly induced by polar stratospheric ozone depletion2, 3, 4. The concomitant southward expansion of the dry subtropical belts5, 6 could have consequences for forest growth. Here, we use tree-ring records from over 3,000 trees in South America, Tasmania and New Zealand to identify dominant patterns of tree growth in recent centuries. We show that the foremost patterns of growth between 1950 and 2000 differed significantly from those in the previous 250 years. Specifically, growth was higher than the long-term average in the subalpine forests of Tasmania and New Zealand, but lower in the dry-mesic forests of Patagonia. We further demonstrate that variations in the Southern Annular Mode can explain 12–48% of the tree growth anomalies in the latter half of the twentieth century. Tree-ring-based reconstructions of summer Southern Annular Mode indices suggest that the high frequency of the positive phase since the 1950s is unprecedented in the past 600 years. We propose that changes in the Southern Annular Mode have significantly altered tree growth patterns in the Southern Hemisphere.

Precocious Puberty in Turner Syndrome Variant

BackgroundTurner syndrome is due to the absence of all or significant parts of one of the sex chromosomes in females. Turner syndrome is a common cause of ovarian failure, and hypergonadotropic hypogonadism occurs in virtually all affected individuals. One case of a variant Turner syndrome with precocious puberty is presented. CaseAn eight-year-old girl was referred with complaints of short stature and breast budding. A physical examination revealed a Tanner stage III for breast development and her bone age was 11 years. Chromosome analysis showed a karyotype of 46,X,del(x)(p11.2). Summary and ConclusionTo preserve growth potential, careful examinations are recommended for pediatric patients with an unusual growth pattern.

Cervical Extradural “En-Plaque” Meningioma

Spinal meningiomas with concurrent extradural localization and "en-plaque" growth are exceptional, with only five reported cases in the literature. We report another case and discuss the peculiar diagnostic and surgical features of this very unusual pattern of growth. A 74-year-old woman was observed because of a rapidly progressive tetraparesis, more marked in the left arm. Magnetic resonance imaging depicted an inhomogeneously enhancing tumor of the cervical spine, extending from C4 to T1, with diffuse dural enhancement and extension into the left brachial plexus roots. At operation by laminotomy from C4 to C7 a firm posterior extradural tumor arising from the dura was resected; however, the diffusely infiltrated dura could not be removed. Histology was in favor of a transitional meningioma (WHO I). Postoperatively, irradiation to the operative field with 50 Gy was performed. At follow-up, 18 months after surgery, clinical improvement to moderate tetraparesis was evidenced. Spinal extradural "en-plaque" meningiomas have been mainly reported in women and at the cervical region, and show extension to many spinal levels as well as diffuse dural infiltration. Preoperatively, they may be differentiated from spinal metastases and lymphomas because of the presence of a "dural tail" sign and calcifications. The surgical resection is mainly limited to the posterior and lateral extradural tumor component, whereas the whole invaded dura is very difficult to resect, mainly in cases with circumferential infiltration. This results in a high rate of tumor recurrence.

Extrauterine leiomyomata presenting with sepsis requiring hemicolectomy Leiomiomas extrauterinos com sepse que exigem hemicolectomia

Extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. Their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. Occasionally, uterine leiomyomas become adherent to surrounding structures. They also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus becoming 'parasitic'. Parasitic myomas may also be iatrogenically created after uterine fibroid surgery, particularly if morcellation is used. This report presented two cases of parasitic myomas with sepsis, both requiring right hemicolectomy. It reviewed the pertinent literature.

Thymomas with prominent signet ring cell–like features: a clinicopathologic and immunohistochemical study of 10 cases

Ten cases of an unusual growth pattern of thymomas are presented. The patients were 8 men and 2 women between the ages of 43 and 62 years. Clinically, 6 patients presented with symptoms of chest pain, cough, and shortness of breath, whereas 4 patients were asymptomatic. Surgical resection of the mediastinal mass was performed in all patients obtaining tumors that varied in size from 4 to 11 cm in greatest dimension. Grossly, the tumors were described as round and well defined, which, at cut surface, showed a firm consistency with a slight lobulated appearance. Areas of necrosis and/or hemorrhage were not present. Histologically, all the tumors showed similar growth pattern characterized by the presence of cells arranged in small cords dissecting fibroconnective tissue and, in some areas, resembling "signet ring" cells. Mitotic activity was not present. Using the Masaoka staging system, 6 cases were in stage I, and 4 cases were in stage II. Histochemical stains for periodic-acid Schiff stain with diastase and mucicarmine were negative for intracytoplasmic mucin. Immunohistochemical studies for CAM5.2 and cytokeratin 5/6 showed a strong positive reaction, whereas thyroid transcription factor 1, epithelial membrane antigen, calretinin, α-fetoprotein, and CD31 were all negative. Follow-up information obtained for 7 patients between 1 and 12 years showed that all these patients are alive and well. The current cases highlight an unusual histologic growth pattern of thymomas that likely can be confused with other tumors of the anterior mediastinum that may require different treatment approaches and carry a different prognosis.

Unusual growth pattern in the Frasnian alveolitids (Tabulata) from the Holy Cross Mountains (Poland)

Abstract: Growth periodicity is a phenomenon occurring in fossil and modern corals. The most apparent feature is growth banding, and environmental changes are broadly accepted as controls on this phenomenon. If environment controls the growth, then all corallites within a colony should repeat the same growth pattern, as individuals are clones and must have shared the same environment. A study on several species of Alveolitidae (Anthozoa, Tabulata) from the Late Devonian (Early Frasnian) of the Holy Cross Mountains (Poland) shows that the growth pattern varies between neighbouring individuals within the same corallum. This contradicts observations of closely related Favositida as demonstrated on Pachyfavosites sp. from the Givetian of Avesnois, France, where neighbouring individuals repeat the same pattern. Therefore, environmental control on growth rhythm in Alveolitidae can be excluded; the causes of differences between individuals remain unknown.

Mantle cell lymphoma with intrafollicular growth pattern

Mantle cell lymphoma (MCL) can show diffuse, nodular and mantle zone growth patterns. We report on two cases of MCL with an unusual intrafollicular growth pattern and discuss the differential diagnosis. The first case was a small lymph node biopsy from a patient with a history of MCL in remission for 6 years. The lymph node showed a preserved architecture but with cyclin D1-positive cells exclusively confined to follicle centers, thus representing an unusual in situ pattern of recurrent disease. The second case was a lymph node biopsy infiltrated with classical diffuse MCL but with areas of intrafollicular growth pattern. Both cases exhibited the classical immunophenotype of MCL with CD20 positivity and co-expression of CD5, cyclin D1, BCL2, and SOX11. Proliferation rate, as assessed by Mib-1 immunostaining was <10% within the infiltrated follicle centers. Fluorescence in situ hybridization analysis demonstrated a break in the CCND1 locus indicative of the t(11;14)(q13;q32), whereas the BCL2 gene locus was intact. Both patients followed a relatively indolent clinical course as compared with classical MCL. It is important to recognize this particular pattern in MCL, since it may occur as minimal lymph node involvement and may also lead to confusion with follicular lymphoma.

Facial Nerve Schwannomas Presenting as Occluding External Auditory Canal Masses

Introduction: Facial nerve schwannomas are rare tumors of the lateral skull base. Treatment options for these tumors include observation, stereotactic radiation, and microsurgical removal. Erosion of the bony posterior canal from the descending segment of an entirely intratemporal tumor is an unusual growth pattern. With tumor in the external canal, a unique set of clinical challenges arises. We discuss the management strategies for facial schwannomas with this unusual growth pattern in patients of two disparate ages.

Adaptive radiation with regard to nutrient sequestration strategies in the carnivorous plants of the genus Nepenthes

Carnivorous pitcher plants of the genus Nepenthes have evolved a great diversity of pitcher morphologies. Selective pressures for maximizing nutrient uptake have driven speciation and diversification of the genus in a process known as adaptive radiation. This leads to the evolution of pitchers adapted to specific and often bizarre source of nutrients, which are not strictly animal-derived. One example is Nepenthes ampullaria with unusual growth pattern and pitcher morphology what enables the plant to capture a leaf litter from the canopy above. We showed that the plant benefits from nitrogen uptake by increased rate of photosynthesis and growth what may provide competitive advantage over others co-habiting plants. A possible impact of such specialization toward hybridization, an important mechanism in speciation, is discussed.

Unusual Radiologic Findings and Pathologic Growth Patterns on Choroid Plexus Papillomas

ObjectiveChoroid plexus papillomas (CPPs) are generally regarded as benign tumors with typical radiologic and pathologic findings. However, they sometimes have unusual findings. We have analyzed radiologic findings and pathologic growth patterns on CPPs.MethodsThe study group included 5 male and 5 female patients (age range, 3 months to 58 years : median, 29 years). The study group included 3 pediatric and 7 adult patients. All patients underwent surgery; 9 patients had a gross total resection and 1 patient had a subtotal resection. We analyzed the radiologic findings (location, size, mottle-like appearance, enhancement, calcifications, and hydrocephalus) and pathologic growth patterns (typical papillary, papillary and solid, and papillary and tubular).ResultsThe median follow-up duration was 21.3 months (range, 4-47.8 months). There were no recurrences after initial treatment. All patients had benign CPPs. Pediatric CPPs were 3.2 cm masses (range, 2.7-4 cm) with homogeneous enhancement and a mottle-like appearance, which pathologically showed the papillary growth pattern. Hydrocephalus was present in all pediatric patients. Postoperatively, subdural hygroma had occurred in two patients. In adults, CPPs were located in the fourth ventricle in 6 patients and suprasellar area in 1 patient. The size varied from 0.5-4.2 cm. Hydrocephalus and calcifications occurred in 3 and 4 patients, respectively. Three patients showed the heterogeneous enhancement without a mottle-like appearance and pathologically showed combined papillary and solid growth in 2 patients and papillary and tubular growth in one. Postoperatively, two patients with large masses had injuries of the brainstem and underwent shunt procedures for aggravation of hydrocephalus.ConclusionCPPs may show unusual radiologic findings, which preoperatively give the difficulty to be differentiated from other tumors. CPPs with unusual radiologic findings showed the combined pathologic growth patterns.

Unique Growth Pattern in Papillary Carcinoma of the Thyroid Gland Mimicking Adenoid Cystic Carcinoma

We report here three cases of papillary thyroid carcinoma (PTC) with hyaline globules as seen in adenoid cystic carcinoma of the salivary glands. This unique growth pattern was seen in two cases of columnar cell and one case of cribriform morular variant of PTC. Fine-needle aspiration was performed in two cases. By immunohistochemistry, all cases demonstrated expression of TTF-1 and thyroglobulin confirming follicular cell derivation. It is important to be aware of this unusual growth pattern in thyroid carcinomas; immunohistochemistry is warranted for rendering accurate cytopathologic and histopathologic diagnosis.

Homozygous microdeletion of the POU1F1, CHMP2B, and VGLL3 genes in chromosome 3—A novel syndrome

Microdeletion syndromes include numerous syndromic phenotypes associated with intellectual disability and dysmorphic features. We report on a patient with a novel microdeletion of chromosomal region 3p11.2-p12.1 containing POU1F1, chromatin-modifying protein 2B (CHMP2B), and vestigial-like 3 (VGLL3) genes. Our patient was diagnosed as having a neonatal multiple pituitary hormone [growth hormone (GH), thyroid-stimulating hormone (TSH), and prolactin] deficiency. In addition to the typical findings associated with these hormonal deficiencies, she exhibited clinical features resembling those of Laron syndrome (frontal bossing, saddle nose, small chin, blue sclera, and acromicria), with moderate intellectual disability. She also displayed an unusual growth pattern characterized by unresponsiveness to high doses of GH replacement therapy during infancy and early childhood and an accelerated growth rate beginning at the age of 4.5 years. Insulin-like growth factor (IGF)-1 levels were consistently extremely low or undetectable. Extensive medical and genetic analysis ruled out primary and secondary GH insensitivity. The distinct phenotype and the peculiar growth pattern observed in this affected patient, not reported to have been observed in other cases with POU1F1 gene inactivity, suggest that the other two deleted genes play a possible role in the development of this syndrome. This hypothesis may be supported by the fact that both the CHMP2B and VGLL3 genes are expressed in the liver and the growth plate, the two main target organs of the GH/IGF-1 axis. The homozygous deletion of the CHMP2B gene, previously associated with frontotemporal dementia, may contribute to the intellectual disability observed in this patient.

Cutaneous Neoplasms With Prominent Verocay Body–Like Structures: The So-called “Rippled Pattern”

A striking appearance resulting from alternating areas of epithelial cell cords and stroma seen in some cutaneous adnexal neoplasms has been referred to as the "rippled pattern." Histologically, this pattern may be indistinguishable from Verocay bodies described in schwannomas. A number of common and clinically diverse cutaneous neoplasms can be linked by the presence of this unusual growth pattern. The heterogeneous group of tumors that have been known to demonstrate this feature includes those with epithelial, adnexal, fibrohistiocytic, mesenchymal, and melanocytic lineage. The objective of this review is to alert the dermatopathologist to the range of neoplasms, which can potentially show this attribute, so that a misdiagnosis can be avoided.

Factors controlling juvenile growth and population structure of the starfishAsterias rubensin intertidal habitats: field and experimental approaches

The dynamics of intertidal populations of the starfishAsterias rubens, living in contrasted habitats and over a broad geographical range, were studied from March 2000 to November 2002 using modal analysis. As only 1 juvenile (first year after recruitment) and 1 adult (subsequent years) modes could be distinguished; only juvenile growth was quantified. Concomitantly, experiments were carried out to test several factors assumed to influence juvenile growth: food quantity and quality, emersion, salinity variations and temperature. Three different juvenile growth patterns were evidenced: (1) a fast and protracted growth linked to high food availability and lack of disturbance; (2) a winter cessation of growth likely due to a seasonal increase of emersion-related stress and salinity variations; and (3) disrupted juvenile dynamics, which was encountered in 2 populations. In the first one, estuarine salinity conditions limited growth and, combined with food depletion, led to the extinction of the population. In the second one, wave action confined most of the population to a restricted area with low food levels. In the third scenario, intraspecific competition for food was probably at the source of an unusual growth pattern in which most juveniles did not grow while a small proportion achieved a medium growth rate.

Nutritional benefit from leaf litter utilization in the pitcher plant Nepenthes ampullaria

The pitcher plant Nepenthes ampullaria has an unusual growth pattern, which differs markedly from other species in the carnivorous genus Nepenthes. Its pitchers have a reflexed lid and sit above the soil surface in a tighly packed 'carpet'. They contain a significant amount of plant-derived materials, suggesting that this species is partially herbivorous. We tested the hypothesis that the plant benefits from leaf litter utilization by increased photosynthetic efficiency sensu stricto cost/benefit model. Stable nitrogen isotope abundance indicated that N. ampullaria derived around 41.7 ± 5.5% of lamina and 54.8 ± 7.0% of pitcher nitrogen from leaf litter. The concentrations of nitrogen and assimilation pigments, and the rate of net photosynthesis (A(N)), increased in the lamina as a result of feeding, but did not increase in the trap. However, maximal (F(v) /F(m)) and effective photochemical quantum yield of photosystem II (Φ(PSII)) were unaffected. Our data indicate that N. ampullaria benefits from leaf litter utilization and our study provides the first experimental evidence that the unique nitrogen sequestration strategy of N. ampullaria provides benefits in term of photosynthesis and growth.

Plexiform leiomyoma of the esophagus: a complex radiographic, pathologic and endoscopic diagnosis

Radiographic identification of an abnormal lesion in the esophagus routinely occurs during workup of patients with symptomatic dysphagia. Leiomyoma is the most common benign finding; however, plexiform leiomyoma, a distinctive but rare variant, follows an unusual pattern of growth which can be a challenging surgical resection. A review of indexed literature identified a single previous report. We contribute a second case of plexiform leiomyoma with a discussion of the clinical, radiographic, and pathologic characteristics, as well as the differential diagnosis for plexiform lesions.