Primary huge gastric leiomyosarcoma with multiple metastases in a 60-year-old female: a case report

Abstract

The incidence of leiomyosarcomas (LMS) has declined drastically. In fact, the introduction of immunohistochemistry (IHC) helped to differentiate LMS from other gastrointestinal stromal tumors (GIST) by receptor tyrosine kinase (KIT)-mutation detection making gastric LMS a sporadic tumor recently. We report a 60-year-old female who presented with a three-week history of abdominal pain. An abdominal computed tomography scan showed a large exophytic mass (22 ×19 ×15 cm) arising from the greater curvature of the stomach with multiple metastases. A biopsy was taken, and the initial histopathological examination was suggestive of GIST. However, further histopathological examination confirmed a high-grade gastric LMS. The patient refused any surgical intervention. Therefore, the patient had only received chemotherapy. On 9-month follow-up, the patient is still alive without disease progression. In conclusion, gastric LMS is a rare tumor. Due to the possibility of being misdiagnosed with other GIST, extensive pathological evaluation through specialized experts and IHC analysis is recommended.

Gastric Leiomyosarcoma in Post–Gastrointestinal Stromal Tumor Era: Revisit

“…Helicobacter pylori may play a role in the development of gastric leiomyosarcoma, 4,5 given its involvement in the pathogenesis of gastric mucosa-associated lymphoid tissue lymphoma and carcinoma 6 . Previous medical histories such as gastroesophageal reflux disease, 7–9 gastritis, 10 GI tract leiomyoma, 4,11 gastric adenocarcinoma, 11 retinoblastoma 12,13 with germline mutation in RB1, mantle cell lymphoma, 14 Wilms tumor, 15 obesity, 16,17 colon cancer, gastric polyp, melanoma, and acoustic neuroma 5 have been reported.…”

“…Treatments for gastric leiomyosarcoma include gastrectomy, 36 laparotomy/laparoscopic wedge resection, 20,21 chemotherapy, 17,38 surgery combined with chemotherapy 28 or adjuvant radiotherapy 8 or imatinib therapy, 25 surgery and Chinese medicine, 1 and hospice care 15 …”