Korean J Gastroenterol.  2015 Feb;65(2):112-117. 10.4166/kjg.2015.65.2.112.

A Case of Gastric Leiomyosarcoma with Multiple Metastases

• Rou WS
• Ju JS
• Kang SH
• Moon HS
• Sung JK
• Lee BS
• Jeong HY
• Song KS

• KMID: 2373192
• DOI: http://doi.org/10.4166/kjg.2015.65.2.112

Abstract

Leiomyosarcoma is an uncommon tumor that originates from various organs, including uterus, kidney, retroperitoneum, and soft tissues. In particular, leiomyosarcoma of the stomach is extremely rare. Only 9 cases have been reported worldwide since the discovery of KIT-activating mutation. A 48-year-old woman was admitted to our hospital with abdominal discomfort and generalized weakness. Upon detection of multiple nodules in both lung on chest posterior-anterior radiograph taken at the time of admission, chest CT was performed and it revealed multiple mass lesions in the lung, liver, and pancreas along with multiple lymph node metastases. On endoscopic examination, a 2.0 cm sized ulcerofungating mass lesion was found on the stomach body. Biopsy was performed and the mass lesion proved to be leiomyosarcoma confirmed by immunohistochemical staining. Chemotherapy was thus initiated, but the patient died after one year due to tumor progression. Our experience suggests that leiomyosarcoma can manifest aggressive behavior in its early stage. Herein, we report a case of gastric leiomyosarcoma with multiple metastases along with review of relevant literature.

Keyword

Leiomyosarcoma; Stomach; Gastrointestinal; Neoplasm metastasis; Immunohistochemistry

MeSH Terms

Female
Gastroscopy
Humans
Leiomyosarcoma/*diagnosis/pathology
Liver Neoplasms/pathology/secondary
Lung Neoplasms/pathology/secondary
Lymphatic Metastasis
Middle Aged
Pancreatic Neoplasms/pathology/secondary
Stomach Neoplasms/*diagnosis/pathology
Tomography, X-Ray Computed

Figure

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  Fig. 1. Chest radiography and computed tomography findings. (A) Chest X-ray image shows multiple nodules in both lungs, which appears to be due to metastasis. (B) Multiple variable-sized nodules are randomly distributed in both lungs, especially in lower lung. (C) Multiple heterogeneously enhancing nodules with peripheral rim enhancement are observed in both lobes of the liver. (D) Multiple low-atte-nuated nodules are also present on the pancreas.

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  Fig. 2. Endoscopic findings of gastric leiomyosarcoma. About 2.0 cm sized ulcerofungating mass lesion is noted on the posterior wall of the gastric upper body.

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  Fig. 3. Microscopic findings of the gastric leiomyosarcoma. (A) At low magnification, the specimen displays plump spindle cells arranged in a fascicular pattern (H&E, ×40). (B) At higher magnification, the tumor cells have eosinophilic cytoplasm with pleomorphic and elongated nuclei, as well as frequent mitoses (H&E, ×200). Staining results (×100) are strongly positive for α-smooth muscle actin (C) and negative for c-kit (D).

Reference

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