gastrointestinal leiomyomas are rare benign tumors incidentally detected during endoscopy in asymptomatic population . clinical presentation may vary from non - specific abdominal pain to life - threatening complications like massive bleeding and perforation requiring emergent surgical interventions . our case is first of its kind in cecum which is managed by endoscopic mucosal resection resulting in complete excision and resolution of symptoms . a 51-year - old woman was referred to gastroenterology clinic for screening colonoscopy . at the initial visit , the patient reported intermittent episodes of rectal bleeding for the last few months prior to the visit . her past medical history was significant for hypertension , diabetes mellitus , dyslipidemia and vitamin d deficiency . on initial evaluation , she was afebrile with heart rate of 86 beats per minute and blood pressure of 160/100 mm hg . laboratory workup revealed a normal hemoglobin of 14.7 g / dl , hematocrit 44% , white cell count of 12.6  10/l and platelets of 255  10/l . she was noted to have two sessile , smooth polypoid lesions measuring 20 mm ( fig . 1 ) and 6 mm in the cecum . 2 ) with interlacing fascicles of spindle shaped cells and cigar shaped nuclei ( fig . 4 ) . section of leiomyoma of cecum showing a downward proliferation of muscularis mucosae which elevated the mucosa . cecal leiomyoma on high magnification showing interlacing fascicles of spindle shaped cells with cigar shaped nuclei . gastrointestinal leiomyomas are smooth muscle tumors arising from the muscularis mucosae , muscularis propriae and possibly from smooth muscle of the vessel wall in the bowel . they are also known to be slow growing tumors predominantly seen in men   and mean age of detection is 62 years . though they are known to occur in the entire gastrointestinal tract , esophagus is reported as the most common site . colonic leiomyomas are uncommon with a reported incidence of 3% of all the gastrointestinal leiomyomas . in the large intestine , recto - sigmoid and descending colon are the most common sites of origin . to the best of our knowledge there were a total of 16 cases of leiomyoma in the cecum and ascending colon out of the total 87 cases in the whole colon , making this tumor in the right colon a very rare one . malignant tumors in turn are primary and metastatic . benign tumors involving the cecum may be hyperplastic polyps , adenomatous polyps and lipomas . leiomyomas can be asymptomatic and can be detected during routine colonoscopy . when symptomatic , the symptoms range from abdominal pain , altered bowel habit and bleeding . bleeding from leiomyoma can vary from being detected on occult blood testing [ 8 , 9 ] to more overt bleeding . massive blood loss needing transfusion , perforation , obstruction , intussusception   and hemoperitoneum   are among the few complications described which generally require surgical intervention . endoscopic snare cauterization with or without saline lift has been described in literature especially for tumors involving the left colon [ 9 , 12 ] . endoscopic submucosal dissection has also been done for leiomyomas of the esophagus and stomach . however , to the best of our knowledge , there have not been reports of such therapy being attempted in the right colon with none reported so far in the cecum . our case proves that such treatment in cecum can be safely attempted with proper technique and expertise . alternatively , the use of endoscopic ultrasound to assess precisely the location and origin of tumor for feasibility of endoscopic resection has also been suggested in literature . however , it should be borne in mind the fact that most of these tumors mimic epithelial polyps in their gross appearance during colonoscopy . . massive bleeding and giant tumors causing compression are some of the clinical scenarios necessitating bowel resection which were also described in literature [ 7 , 16 , 17 ] . we are not aware of any specific recommendations for follow - up after resection , although this is probably based on the clinical scenario and type of treatment and completeness of resection .
gastrointestinal leiomyomas are smooth muscle tumors arising from the muscularis mucosae , muscularis propriae and possibly from smooth muscle of the vessel wall . 
 management depends on the size , location and the clinical scenario . 
 endoscopic snare cauterization with or without saline lift has been described in literature for tumors involving the left colon . to the best of our knowledge , endoscopic resection of right colon leiomyoma 
 was never attempted in the past . 
 we present a case of cecal leiomyoma which was resected endoscopically .