Figure 1
Leiomyosarcoma of the stomach
A 6 x 6 cm submucosal mass arises from the lesser curvature of the body of stomach with a large ulcer on the luminal surface containing an entrapped gas locule.
Clinical History
40 year old female presents with malena and iron deficient anemia. Upper GI endoscopy revealed a gastric mass.
Imaging Findings
40 year old female presents with malena and iron deficient anemia. Upper GI endoscopy revealed a gastric mass.
Discussion
Leiomyosarcoma of the stomach are also known as malignant gastrointestinal stromal tumors. They represent up to 3% of all gastric malignancies. Most malignant stromal tumors of the GI tract arise from the stomach. There is a 2:1 male predominance with a wide age range at the time of presentation.
90% arise from the gastric fundus or body, with 10% arising from the gastric antrum. These tumors are best characterized on contrast enhanced CT. 50% are intramural, 35% exogastric and 15% endogastric. Exogastric leiomyosarcomas have a predominantly exophytic component and may mimic tumors arising from adjacent viscera such as pancreas. Larger exophytic lesions can cause extrinsic mass effect on adjacent viscera. Endogastric leiomyosarcomas appear pedunculated. Gastric leiomyosarcomas are typically large, lobulated masses. They may undergo tumor hemorrhage or necrosis. Tumor hemorrhage appears as areas of mixed attenuation and contrast enhancement depending on the temporal interval from hemorrhage. Tumor necrosis results in one or more ulcers, or areas of cavitation. Tumor cavitation appears as areas of lower attenuation with some appearing as fluid density. Dystrophic calcifications may also be found. Advanced disease results in hepatic or peritoneal metastases. Hepatic metastases may be hypervascular. Regional nodal metastasis is uncommon. An uncommon association is Carney syndrome. This is a triad of gastric epitheliod leiomyosarcoma, functioning extra-adrenal paraganglioma, and pulmonary chondromas.
These tumors are ultimately diagnosed by histology. They are more likely to be malignant in larger tumors which have areas of cavitation or ulceration. Differential diagnosis include other benign or malignant mesenchymal tumors, lymphoma, or metastases.
Differential Diagnosis List
Leiomyosarcoma of the gastric body
Final Diagnosis
Leiomyosarcoma of the gastric body
References
[1]
Levine MS, Megibow AJ
Other malignant tumors of the stomach and duodenum.
In Gore RM, Levine MS (ed) Textbook of gastrointestinal radiology.
WB Saunders, Philadelphia, pp 645-648 (2000).
[2]
Dahnert W
Urogenital tract.
In Radiology review manual.
Williams and Wilkins, Baltimore, pp 763 (1999).
[3]
Davis GB, Blanchard DK, Hatch GF, Wertheimer-Hatch L, Hatch KF, Foster RS, Skandalakis JE
Tumors of the stomach
World J Surgery 2000 Apr; 24(4):412-420. (PMID: 10706913)
Case information
| URL: | https://eurorad.org/case/760 |
| DOI: | 10.1594/EURORAD/CASE.760 |
| ISSN: | 1563-4086 |
Leiomyosarcoma of the stomach
A 6 x 6 cm submucosal mass arises from the lesser curvature of the body of stomach with a large ulcer on the luminal surface containing an entrapped gas locule.