J Gastric Cancer.  2015 Mar;15(1):64-67. 10.5230/jgc.2015.15.1.64.

Inflammatory Myofibroblastic Tumor Treated with Laparoscopic Proximal Gastrectomy and Double-Tract Anastomosis

• Kim DJ
• Kim W

• KMID: 2372373
• DOI: http://doi.org/10.5230/jgc.2015.15.1.64

Abstract

Inflammatory myofibroblastic tumors (IMTs) of the stomach are extremely rare in adults, and their oncologic prognosis is not well understood. We present a 28-year-old man with a proximal gastric IMT. The patient visited the emergency department of Yeouido St. Mary's Hospital with syncope and hematemesis. Hemoglobin levels were <5.5 g/dl. Gastric fibroscopy showed a protruding mass 4x4 cm in size, with central ulceration on the posterior wall of the fundus and diffuse wall thickening throughout the cardia and anterior wall of the upper body. Endoscopic biopsy revealed indeterminate spindle cells, along with inflammation. Given the risk of rebleeding, an operation was performed despite the uncertain diagnosis. Because the mass was circumferential, laparoscopic proximal gastrectomy and double-tract anastomosis were performed to ensure a safe resection margin. The pathological diagnosis was consistent with an IMT originating from the stomach, although the tumor was negative for anaplastic lymphoma kinase gene mutation.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy

MeSH Terms

Adult
Biopsy
Cardia
Diagnosis
Emergency Service, Hospital
Gastrectomy*
Hematemesis
Humans
Inflammation
Laparoscopy
Lymphoma
Myofibroblasts*
Phosphotransferases
Prognosis
Stomach
Stomach Neoplasms
Syncope
Ulcer
Phosphotransferases

Figure

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  Fig. 1 Preoperative endoscopic and biopsy findings. (A, B) Protruding mass 4×4 cm in size with central ulceration. (C) Two submucosal tumors on the lesser curvature side of the cardia and upper body. (D) Histological examination of the fundic mass revealed nonspecific spindle cells and inflammatory cells (H&E, ×100).

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  Fig. 2 Computed tomography scan shows fundic mass with diffusely thickened gastric wall on the lesser curvature side of the upper body and cardia. (A) Axial image. (B) Coronal image.

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  Fig. 3 (A) Opened specimen shows protruding mass on posterior wall of fundus and diffuse wall thickening of cardia and high body (*esophageal mucosa). (B) Cut section shows large mass with infiltration into the muscle layer.

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  Fig. 4 Histological findings show spindle-shaped tumor cells under a myxoid stroma with lymphoplasmacytic infiltration among the tumor cells. (A) H&E, ×40. (B) H&E, ×100. (C) H&E, ×400. (D) Actin (+), ×400. (E) CD117 (-), ×400. (F) Anaplastic lymphoma kinase mutation (-), ×400. (G) IgG (+), ×400. (H) IgG4 (+), ×400; IgG4/IgG ratio <0.4. IgG = immunoglobulin G.

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