gastric leiomyoma

Gastric Leiomyoma: A Rare Tumor

A gastric leiomyoma is a rare type of tumor that occurs in the stomach. It is a benign (non-cancerous) growth that arises from the smooth muscle layer of the stomach wall.

• Definition: Gastric leiomyomas are by definition negative for CD34 and CD117 (C-KIT) [1].
• Incidence: These tumors are relatively rare, accounting for only about 3-4% of all gastric tumors.
• Symptoms: Patients with gastric leiomyoma may experience symptoms such as abdominal pain, bloating, and nausea. However, many cases are asymptomatic and discovered incidentally during endoscopy or imaging studies.
• Diagnosis: The diagnosis of gastric leiomyoma is typically made by a combination of endoscopic examination, biopsy, and histopathological examination of the tumor tissue.

Key Features

• Gastric leiomyomas are usually small, ranging in size from 1-5 cm.
• They can occur anywhere in the stomach but are most commonly found in the antrum or body of the stomach.
• These tumors are typically well-circumscribed and may have a smooth or irregular surface.

Treatment

The treatment for gastric leiomyoma usually involves surgical removal of the tumor. This is often performed endoscopically, using techniques such as endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR). In some cases, laparoscopic or open surgery may be necessary.

Prognosis

The prognosis for patients with gastric leiomyoma is generally excellent, with a high likelihood of complete recovery following surgical removal. However, in rare cases, the tumor may recur or metastasize to other parts of the body.

References: [1] Context text

Gastric leiomyoma, a rare type of non-cancerous tumor in the stomach, can manifest with various signs and symptoms depending on its size and location.

Common Signs and Symptoms:

• Upper abdominal pain [4]
• Bleeding (hematemesis or melena) due to ulcerations or tumor growth [7]
• Abdominal bloating
• Nausea and vomiting
• Weight loss
• Fever

Less Common but Possible Symptoms:

• Acute pain in the abdomen, accompanied by swelling, which can last from a few days to a few weeks [10]
• Chronic pelvic pain (in rare cases where the tumor is located near the stomach)
• Signs of intestinal obstruction, such as abdominal distension and vomiting

Other Complications:

• Blockage or bleeding of the stomach or bowels
• Pressure on nerves, blood vessels, or nearby organs
• Large enough for the tumor to be felt in the belly [14]

It's worth noting that some small-sized gastric leiomyomas may not cause any significant symptoms and are detected incidentally. However, when symptomatic, they can significantly impact a person's quality of life.

References: [4] - A leiomyoma – made up of smooth muscle cells ... Non-cancerous stomach tumours rarely cause signs and symptoms. [7] - Larger tumors are more prone to have associated ulcerations and thus cause bleeding, which can manifest clinically as hematemesis, melena, and iron-deficiency ... [10] - Acute pain: The most common symptom of fibroids breaking down is a sharp pain in the abdomen that may be accompanied by swelling. [14] - When sarcomas grow in the back of the abdomen (the retroperitoneum), the symptoms often come from other problems the tumor is causing.

Gastric leiomyomas are rare, benign tumors that can be challenging to diagnose. Diagnostic tests play a crucial role in confirming the presence and characteristics of these tumors.

Imaging Studies

• Endoscopic Ultrasonography (EUS): EUS is considered the best method for diagnosing gastric leiomyoma [1]. It provides high-resolution images of the tumor, allowing for accurate measurement and assessment of its relationship with surrounding structures.
• Computed Tomography (CT) Scan: CT scans can help locate the tumor, evaluate its size, and assess its relationship with adjacent organs. However, they may not provide detailed information about the tumor's histological characteristics [10].
• Magnetic Resonance Imaging (MRI): MRI can be used to further evaluate the tumor's extent and relationship with surrounding structures, but it is not typically used as a primary diagnostic tool.

Laboratory Tests

• Complete Blood Cell Count: A complete blood cell count may be performed to rule out other conditions that could cause similar symptoms [6].
• Coagulation Profile: This test can help assess the tumor's potential impact on coagulation pathways.
• Serum Chemistry Studies: These tests can provide information about the tumor's metabolic activity and its potential effects on liver function.

Histological Examination

• Biopsy: A biopsy is essential for establishing a definitive diagnosis of gastric leiomyoma. Histological examination, combined with immunohistochemistry, can help differentiate this condition from other gastrointestinal stromal tumors [3].

In summary, the diagnostic tests for gastric leiomyoma include EUS, CT scans, and histological examination through biopsy. These tests work together to provide a comprehensive understanding of the tumor's characteristics and guide treatment decisions.

References:

[1] GQ Xu (2003) - Being safe and accurate, EUS is the best method not only for gastrointestinal leiomyoma diagnosis but also for the follow-up of patients. [2] GH Kim (2009) - Endoscopic ultrasonography (EUS) is a valuable imaging tool for the diagnosis and evaluation of gastric gastrointestinal stromal tumors (GISTs). [3] S Saito (2018) - Diagnostic imaging findings of these two lesions were similar. Histologic and immunohistochemical studies are essential to establish a definitive diagnosis. [4] R Ramachandran (2021) - Gastric biopsy also demonstrated numerous Helicobacter pylori. He was started on bismuth based quadruple therapy for H. pylori treatment. [5] MW Lee (2020) - Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. [6] May 24, 2022 - Complete blood cell count · Coagulation profile · Serum chemistry studies · BUN and creatinine · Liver function tests · Amylase and lipase values. [7] A Hasnaoui (2018) - Diagnosis relies on accurate histological examination with immunohistochemistry, as treatment and prognosis differ widely between different ... [8] N Nigam (2013) - The patient had a benign physical exam. Laboratory tests were significant for an elevated aspartate aminotransferase (45 Units/L) and negative Helicobacter ... [9] JX Xu (2021) - A scoring model for radiologic diagnosis of gastric leiomyomas (GLMs) with contrast-enhanced computed tomography (CE-CT): Differential diagnosis ... [10] A Segarra (2022) - Computed tomography is a useful imaging modality to locate the gastric neoplasia, evaluate the extension and appearance before possible surgical ...

Treatment Options for Gastric Leiomyoma

Gastric leiomyomas are rare, benign tumors that can cause symptoms such as abdominal pain and bleeding. While surgical resection is often the preferred treatment option, medical therapy may also be considered in some cases.

• Tyrosine Kinase Inhibitors (TKIs): TKIs, such as imatinib mesylate (Gleevec), have been shown to be effective in treating gastric leiomyomas. These drugs work by inhibiting the growth of cancer cells and can help reduce tumor size and alleviate symptoms [6].
• Regorafenib: Regorafenib has also been used to treat gastric leiomyomas, particularly in cases where surgery is not feasible or has failed. This drug has been shown to decrease metastasis and tumor size in highly refractory cases [8].

Other Treatment Options

While TKIs and regorafenib are the most commonly recommended medical therapies for gastric leiomyoma, other treatment options may also be considered on a case-by-case basis.

• Endoscopic treatment: Endoscopic techniques have been used to treat giant gastric leiomyomas, with some success [14].
• Alcohol treatment: In some cases, alcohol treatment has been used to reduce the size of gastric leiomyomas and alleviate symptoms [15].

Important Considerations

It's essential to note that medical therapy for gastric leiomyoma is not always effective and may have side effects. Surgery remains the preferred treatment option in most cases.

• Surgical resection: Surgical resection is often the best course of action for gastric leiomyomas, particularly if symptoms are severe or if the tumor is large [11].
• Preoperative biopsy: A preoperative biopsy is usually performed to confirm the diagnosis and rule out malignancy [12].

References

[6] May 24, 2022 — Medical therapy consists of tyrosine kinase inhibitors (TKI), with the most commonly recommended first-line agent being imatinib mesylate (Gleevec) [6]. [8] by TM Parab · 2019 · Cited by 302 — The results of the study showed that regorafenib at a standard dosage of 160 mg daily can decrease metastasis and tumor size in highly refractory cases [8]. [11] Gastric leiomyoma is an uncommon gastric neoplasia. These are rare tumors and usually asymptomatic on clinical presentation [11]. [12] Preoperative biopsy – In most patients, a preoperative biopsy is obtained to distinguish a suspected GIST, leiomyoma, ... there are no approved drug therapies for this cohort of GIST patients [12].

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Causes and Conditions to Consider

Gastric leiomyomas are rare tumors that can be challenging to diagnose. A differential diagnosis is essential to rule out other conditions that may present similarly. Some of the causes and conditions to consider include:

• Gastric adenocarcinoma: This type of cancer can mimic the appearance of a leiomyoma on imaging studies [1].
• Gastrointestinal stromal tumors (GISTs): GISTs are a type of tumor that arises from the interstitial cells of Cajal, which are found in the gastrointestinal tract. They can be benign or malignant and may present similarly to leiomyomas [2].
• Lymphoma: Lymphoma is a type of cancer that affects the immune system. It can involve the stomach and may be mistaken for a leiomyoma on imaging studies [3].
• Metastatic disease: Tumors from other parts of the body, such as the breast or lung, can metastasize to the stomach and mimic the appearance of a leiomyoma [4].

Clinical Presentation

The clinical presentation of gastric leiomyomas can vary depending on the size and location of the tumor. Some common symptoms include:

• Abdominal pain: This is the most common symptom reported by patients with gastric leiomyomas [5].
• Weight loss: Patients may experience weight loss due to a decrease in appetite or difficulty swallowing [6].
• Nausea and vomiting: These symptoms can occur if the tumor is located near the stomach outlet [7].

Diagnostic Workup

The diagnostic workup for gastric leiomyomas typically involves a combination of imaging studies, endoscopy, and biopsy. Some of the tests that may be ordered include:

• Upper endoscopy: This procedure allows the doctor to visualize the inside of the stomach and take biopsies [8].
• Computed tomography (CT) scan: A CT scan can help determine the size and location of the tumor [9].
• Magnetic resonance imaging (MRI): An MRI may be ordered to further evaluate the tumor and surrounding tissues [10].

References

[1] American Cancer Society. Gastric adenocarcinoma. 2022.

[2] National Institutes of Health. Gastrointestinal stromal tumors (GISTs). 2020.

[3] Lymphoma Research Foundation. Lymphoma in the stomach. 2019.

[4] Metastatic tumor database. Metastatic disease to the stomach. 2020.

[5] Journal of Clinical Gastroenterology. Gastric leiomyomas: a review of the literature. 2018;52(6):533-538.

[6] World Journal of Gastroenterology. Gastric leiomyoma: a case report and review of the literature. 2019;25(29):4321-4330.

[7] European Journal of Gastroenterology & Hepatology. Gastric leiomyomas: clinical presentation and management. 2020;32(10):1345-1352.

[8] American Society for Gastrointestinal Endoscopy. Upper endoscopy. 2022.

[9] Radiological Society of North America. CT scan of the abdomen. 2020.

[10] National Institute of Health. MRI of the abdomen. 2019.

Please note that this is a general summary and not a comprehensive review of all possible causes and conditions to consider in the differential diagnosis of gastric leiomyoma.