Undifferentiated Sarcoma of the Stomach: A Rare Entity

Abstract

Purpose: A 79-year-old male with history of hypertension and CAD presented to the ER with melena for 3 days, dizziness and weakness. He denied history of smoking or alcohol abuse. Medications included daily aspirin. BP on admission was 94/52, pulse 110/min; cool, clammy skin and black tarry stool were noted. Initial hemoglobin was 8.2 g/dl. After rapid resuscitation and intensive care, emergent EGD showed a 2 cm deep ulcerated lesion in the gastric cardia with no active bleed. Biopsy was performed; histology subsequently revealed high grade undifferentiated sarcoma. CT chest/abdomen/pelvis was negative for metastasis. EUS showed a hypoechoic lesion in the muscularis propria. He underwent a partial gastrectomy and is currently doing well. Although Kaposi sarcoma, myeloid sarcoma and metastatic soft tissue sarcoma in the stomach have been sparingly described, undifferentiated sarcoma is exceedingly rare. Patients typically present with vague abdominal pain. GI bleed is rare but may occur in deep vascular lesion as in our case. No genetic or environmental associations have been characterized. We present a rare form of gastric sarcoma causing massive upper GI bleed.Figure: [669] Gross appearance of lesion on EGD.Figure: [669] Radial EUS showing a 2x1 cm hypoechoic lesion arising from the muscularis propria.Figure: [669] Vimentin (Sarcoma tumor marker) stain 20X.