Loss of peristalsis of the esophagus due to diffuse esophageal leiomyomatosis.

A 15-year-old girl was referred to our hospital with a tumor in the mediastinum that had been found on a chest radiograph during a medical check-up. An esophagram showed a large mediastinal mass (60mm in diameter) (▶Video1). No peristalsis of the thoracic esophagus (smooth muscle area) was apparent, and dilatation of the esophagus and retention of the barium were observed on the proximal side of the tumor. High resolution manometry (HRM) findings showed complete loss of peristalsis of the smooth muscle area, whereas peristalsis of the striated muscle area was preserved (▶Fig. 1). Although the esophageal lumen was narrowed by the tumor, the endoscope could be passed through it (▶Fig. 2). Computed tomography (CT) scanning demonstrated a mildly enhancing tumor, which was circumferentially surrounding the lower esophagus (▶Fig. 3). On T1-weighted magnetic resonance imaging (MRI), the tumor had a relatively high signal, which was the same as that of other muscular organs (▶Fig. 4). The patient underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), with the endoscopic ultrasound showing that the tumor had a mosaic echo, and that there was a clear boundary between the tumor and other organs (▶Fig. 5). Biopsy specimens E-Videos