Case Of Gastric Leiomyosarcoma Research Articles

Gastrointestinal Leiomyosarcoma with Disease Progression to the Central Nervous System: Case Report

Introduction: Leiomyosarcomas (LMS) are rare malignant neoplasms with smooth muscle differentiation, which occur more commonly in the uterus, digestive tract or retroperitoneum. Before 2000, the mesenchymal gastric tumors were divided in leiomyomas, leiomyoblastomas and leiomyosarcomas. After discovery of the role of KIT oncogene, a distinct entity in the mesenchymal gastrointestinal tumors line has surfaced: GIST (Gastrointestinal Stomal Tumors). The true gastric leiomyosarcoma has become a rare entity. The presentation with brain metastasis had only been reported in the pre-GIST era. Case report: A female, 57 years old, admitted in October 2013, for investigation of abdominal pain, finding a lesion in the left illiac fossa continuing with the terminal ileum. She was submitted to the resection of the lesion with histopathological result showing leiomyosarcoma (6 mitotic figures/10 high power field; IHQ: vimentin positive, S-100 negative, desmin positive). Started chemotherapy. However, presented progression of the disease for subcutaneous tissue, liver (submitted to radiotherapy) and nervous system (only one lesion in the posterior fossa). The patient was submitted in March 7th 2016 to suboccipital craniotomy and en-block resection of the lesion. The microscopic examination revealed a fasicular spindle cell malignant neoplasm, with necrotic areas, with intense and diffuse desmin and smooth muscle actin-positivity in immunohistochemical study, which confirmed the leiomyosarcoma metastatic lesion hypothesis. The patient evolved well during the postoperative period, it was peformed the postoperative MRI, that showed a satisfactory resection. She remained hospitalized until the fourth postoperative day, with no complications, and was then discharged for outpatient follow-up. Conclusion: We have described a case of gastric leiomyosarcoma, emphasizing that even in front of the rarity of leiomyosarcoma itself as a primary lesion (especially after the discovery of GIST as an independent mesenchymal line tumor), this lesion may progress and present central nervous system metastasis, a fact not before reported in literature.

Primary leiomyosarcomas of the gastrointestinal tract in the post–gastrointestinal stromal tumor era

Most mesenchymal neoplasms of the gastrointestinal tract are currently classified as gastrointestinal stromal tumors (GIST). Gastrointestinal stromal tumors are diagnosed by immunopositivity for CD117, CD34, and DOG1.1, with or without molecular analyses. According to the World Health Organization classification, the diagnosis of primary leiomyosarcomas of the gastrointestinal tract is so rare that there are no significant data on demographic, clinical, or gross features of this tumor. A comprehensive literature search was performed to identify gastrointestinal leiomyosarcomas. Searches were limited to the past 12 years because definitive tools to differentiate leiomyosarcomas from GIST were introduced in the late 1990s. Cases were included only if convincing data were presented. Six cases of esophageal leiomyosarcoma and 5 cases of gastric leiomyosarcoma were confirmed. Furthermore, 26 cases of leiomyosarcoma of the small bowel, 11 cases of the colon, and 8 cases arising in the rectum were identified. Finally, 28 cases of infantile and adolescent leiomyosarcoma were reviewed. Although survival analysis is precluded by small case numbers and limited survival data availability, the trend identifies that increased size and mitotic activity portends to a worse prognosis in small bowel leiomyosarcomas. Colonic leiomyosarcomas appear to be aggressive tumors, regardless of tumor size and mitotic activity. Rectal leiomyosarcomas present as smaller tumors with favorable prognosis. Leiomyosarcomas in post-GIST era are rare tumors of the gastrointestinal tract with distinctive clinicopathologic characteristics. Owing to different treatment options, it is necessary to accurately differentiate these from GIST, using a combination of histologic appearance, presence of smooth muscle antigens, and absence of specific GIST immunomarkers.

Primary Gastric Leiomyosarcoma in Young Revealed by a Massive Hematemesis

Leiomyosarcomas are one of the most common soft tissue sarcomas, usually seen in deep, soft tissues of the extremities and retroperitoneum. Leiomyosarcoma primarily involving the gastrointestinal tract is uncommon. We present here a rare case of gastric leiomyosarcoma revealed by a massive hematemesis in a young woman. We present a case of primary gastric leiomyosarcoma in a 16-year-old woman who presented with massive hematemesis. Computed tomography scan examination revealed a tumor mass located in the anterior wall of the upper body and protruding into the lumen. The patient was treated by subtotal gastrectomy. The histological examination confirmed the diagnosis of leiomyosarcoma of the stomach. Primary stomach leiomyosarcoma is rare, accounting for only 1% of gastric tumors. Endoscopic ultrasound and biopsy are helpful in establishing the diagnosis. Surgical resection is the treatment of choice for gastric leiomyosarcomas.

腹腔内出血にて発症した胃平滑筋肉腫の１例

胃平滑筋肉腫は胃悪性腫瘍の0.5～2%を占めるが, 一般に腹痛, 消化管出血, 腹部腫瘤などで発見されることが多く, 腹腔内出血を来した症例はまれである. 我々は極めて腫瘍径の小さい平滑筋肉腫破裂の若年者症例を経験したので報告する. 症例は25歳の男性. 起床時, 突然の心窩部痛にて発症し, 急性汎発性腹膜炎の診断で入院した. 腹部CT, 消化管内視鏡, 超音波内視鏡などで腹腔内出血を伴う, 約8cmの胃平滑筋肉腫と診断し, 開腹術を施行した. 腹腔内には約600mlの出血を認め, 胃前庭部の腫瘤のほとんどが血腫であり, 腫瘍は2.3×2.0cmであった. 病理組織学的には, 低悪性度平滑筋肉腫であり腫瘍径も小さく, 4年6か月経過した現在も再発の兆しはない.

A CASE OF GIANT GASTRIC LEIOMYOSARCOMA WITH RENAL CELL CARCINOMA WITH MULTIFOCAL LIVER AND RETROPERITONEAL METASTASIS

A 74-year-old male was admitted to the hospital because of anorexia and dizziness. There was an infant's head sized mass palpable in the left upper quadrant. Abdominal CT revealed an infant's head sized mass in the left upper quadrant and a nut sized mass in the cranial lesion of left kidney. Gastric leiomyosarcoma with renal cell carcinoma was suspected, and total gastrectomy with resections of the spleen, body and tail of the pancreas and left hemicolon, and the resections of the left kidney and adrenal gland were performed. Histological examination of the resected specimens revealed gastric leiomyosarcoma and renal cell carcinoma. The patient died of multifocal liver and retroperitoneal metastasis due to the gastric leiomyosarcoma 13 months after the operation. In Japan, gastric leiomyosarcoma is relatively rare, especially that associating with renal cell carcinoma. This case of synchronous double cancer may be the second case seen in the Japanese literature as far as we could review. There is no aggreement upon how it should be treated. We should accumurate more cases of gastric leiomyosarcoma in the future and establish the clear guidelines for the treatment.

４回の腹腔内再発を切除しえた胃平滑筋肉腫の１例

４回の腹腔内再発を切除しえた胃平滑筋肉腫の１例

Gastric Leiomyosarcoma: Two Unusual Cases

Two cases of gastric leiomyosarcoma, which presented unusually with lower abdominal masses, are described. The difficulties in the preoperative diagnosis of this rare malignancy are discussed.

胃部分切除術後，断端部再発をきたした胃平滑筋肉腫の１例

胃部分切除術後，断端部再発をきたした胃平滑筋肉腫の１例

A Case of Gastric Leiomyosarcoma

A Case of Gastric Leiomyosarcoma