GASTRIC STROMAL TUMOR WITH PERITONEAL METASTASES-A CASE REPORT-

Abstract

A 70-year-old man was admitted to the hospital because of abdominal distension. A mass about 10cm in diameter was palpable in the left upper abdomen. Upper gastrointestinal roentogenogram and endoscopic examination of the stomach showed extensive impingement of the posterolateral wall in the body of stomach. Abdominal computed tomography showed a 16cm mass in the left superior abdominal space. An operation was performed under a radiological diagnosis of a giant tumor in the abdominal space. Peritoneal metastases at the greater omentum and retroperitoneum were identified intraoper-atively. The giant mass arose from the posterior wall of the gastric body and invaded the left diaphragm. Total gastrectomy and lymph node dissection (D2) were performed. The specimen had foci of hemorrhage and necrosis, and weighted 3141g. Morphological diagnosis was leiomyosarcoma with no lymph node metastasis. On immunohistochemical examinations, tumor cells were negative for smooth-muscle actin and desmin of the muscle marker, and negative for S100 protein and neuron specific enolase of the neurogenic marker. But the lesions were positive for CD34. From immunohistochemical features, the tumor was diagnosed as gastrointestinal stromal tumor of uncommitted type. Multiple hepatic and peritoneal metastases were revealed, as of 10 months after the operation.