Clinical features,diagnosis and treatment of 55 cases of colorectal polypoid leiomyomas
Objective To evaluate the clinical manifestations,endoscopic treatment and histopathological characteristics of colorectal polypoid leiomyoma.Methods A retrospective analysis was conducted on the clinical data of 55 patients diagnosed with colorectal leiomyoma who underwent endoscopic resection or forceps from January 2012 to December 2022.The clinical manifestations,endoscopic manifestations,histopathology and treatment status were analyzed.Results This group of cases accounted for 1.3％(55/4230)of colorectal polypoid lesions during the same period.Colorectal leiomyoma was more common in middle-aged and elderly men,with a gender ratio of 2.2∶1 and a median age of 58 years.Common clinical symptoms included abnormal bowel movements,abdominal pain and bloody stools.The most common location was the left colon,especially sigmoid colon(n=44).Most tumors were polypoid lesions smaller than 1cm,with an average size of 5.6 mm.All 55 patients underwent endoscopic resection or forceps,of whom 18 underwent biopsy forceps removal and 37 underwent routine polypectomy or endoscopic mucosal resection.There were no postoperative complications such as bleeding or perforation.No local residual lesions or recurrence were found during endoscopic follow-up in 28 patients.The accuracy of endoscopic diagnosis of leiomyoma was 29.1％(16/55),and the remaining cases were misdiagnosed as polyps.Fifty-three cases originated from the mucosal muscle layer,and 2 cases originated from the intrinsic muscle layer.The tumor boundary was clear under the microscope,and the tumor cells was composed of low-density spindle shaped cells with consistent morphology,distributed in a diffuse or bundle shape.The cytoplasm of the tumor cells was rich in red staining,and the nucleus was spindle shaped with blunt circles at both ends,which resembling a cigar smoke.And the chromatin was fine without abnormalities.In addition,pathological mitosis was rare,and transparent degeneration and calcification could be seen in the interstitium.As 29 cases underwent immunohistochemical staining,it was showed that SMA and Desmin were all positive,CD117,CD34,Dog-1,S-100,CK were all negative,and the Ki-67 index was less than 1％.Conclusion Colorectal leiomyomas are rare.For polypoid leiomyomas,endoscopic resection or biopsy forceps removal is a less invasive and cost-effective surgery with fewer complications and a low tumor recurrence rate.
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