A 43-year-old male, previously healthy and asymptomatic, attended the thoracic surgery department in order to complete the study of a middle mediastinal tumour identified in a routine study.

In the pharyngo-oesophageal study, after the administration of barium contrast, a stenosis of about 3 cm in length was observed in the middle third of the oesophagus with well-defined contours and which reduced the oesophageal lumen by 50%. These findings are compatible with an extrinsic compressive process.

A three-way right videothoracoscopy was performed. The presence of a tumour was identified in the middle mediastinum at the level of the azygos vein (cephalic to this vein), mobile, hard, with no adhesions to adjoining structures. Dissection is started by opening the mediastinal pleura and separating the tumour from what appears to be the muscular fibres of the oesophagus (this is done using a videothoracoscopy hook and an electric scalpel). The tumour, which measures approximately 3 cm in diameter, is then enucleated. The oesophageal mucosa is identified at its deep edge and its tightness is checked.
The postoperative course was uneventful and the patient was discharged after 48 hours. At the review carried out 6 months after surgery, the patient was asymptomatic and living a completely normal life, with no dysphagia or symptoms of gastro-oesophageal reflux, afebrile and with normal respiratory function tests.
The anatomopathological report of the fragment was diagnosed as an oesophageal leiomyoma. Macroscopically, it was 5 cm in size, irregular in shape, with a polylobulated surface and a certain tendency to form swirls. Microscopically, the tumour consisted of bundles of smooth muscle fibres strongly positive for anti-actin, multidirectional in arrangement, without cellular atypia or mitosis. Occasionally, hyaline amorphous material appears in the form of irregularly distributed droplets.