Main Article Content

Abstract

Background:
Leiomyosarcoma (LMS) represents about 1% of primary malignancies of the stomach, usually evolves with hepatic implants in 2-thirds of cases, and the outcome is frequently poor. With an insidious course, late diagnosis and misdiagnosis with other gastric neoplasia occur. Immunohistochemical evaluations are mandatory to confirm the diagnostic hypothesis. Surgical resection has been the more effective treatment of
gastric LMS; however, recurrences after resections and distant metastases may develop in up to 50% of the patients. Doxorubicin, gemcitabine, and docetaxel are therapeutic options, with variable responses.
Case presentation:
The 52-year-old male herein described with a diagnosis of LMS in the gastric pouch and liver metastasis underwent a Roux-en-Y bypass to treat morbid obesity more than a decade ago. Persistent abdominal pain was a unique symptom, and he had liver metastasis at diagnosis. The initial hypothesis was a metastatic gastrointestinal stromal tumor (GIST) of the excluded stomach and the patient underwent a schedule with imatinib without significant response. After a complete revision of the anatomopathological findings,
the patient underwent a new biopsy of the gastric mass, and the immunohistochemical data were consistent with LMS. Then doxorubicin replaced imatinib, later changed by gemcitabine associated with docetaxel. As last control found lesions in the central nervous system, he is under radiotherapy sessions.
Conclusion:
The diagnosis of gastric LMS often occurs at late stages because of the insidious clinical course. The rate of liver metastasis at diagnosis is high. Besides, the relatively poor response to the alternative management for non-surgical stages of the disease yields severe outcomes.

Keywords

Leiomyosarcoma liver metastasis Roux-en-Y gastric bypass surgery

Article Details

How to Cite
Silva, N. A., Santos, L. A. M., & Santos, V. M. (2020). Metastatic leiomyosarcoma of the excluded stomach: a case report . Journal of Gastric Surgery, 2(3), 98-101. https://doi.org/10.36159/jgs.v2i3.57

References

  1. [1] Cheng CS, Chen L, Xie J, Chen Z. Multimodality palliative treatment with transarterial chemoembolization and high-intensity focused ultrasound for gastric leiomyosarcoma multiple liver metastasis pain: A case report. Medicine (Baltimore). 2019;98(39):e17328.
  2. [2] Gubatan J, Shah N. Gastric leiomyosarcoma unmasked by bleeding from a percutaneous endoscopic gastrostomy tube. ACG Case Rep J. 2020;7(1):e00301.
  3. [3] Hasnaoui A, Jouini R, Haddad D, Zaafouri H, Bouhafa A, Ben Maamer A, et al. Gastric leiomyosarcoma and diagnostic pitfalls: a case report. BMC Surg. 2018;18(1):62.
  4. [4] Kang WZ, Xue LY, Tian YT. Leiomyosarcoma of the stomach: A case report. World J Clin Cases. 2019;7(21):3575-82.
  5. [5] Kawaguchi K, Igarashi K, Murakami T, Kiyuna T, Nelson SD, Dry SM, et al. Combination of gemcitabine and docetaxel regresses both gastric leiomyosarcoma proliferation and invasion in an imageable patient-derived orthotopic xenograft (iPDOX) model. Cell Cycle. 2017;16(11):1063-9.
  6. [6] Mehta V, Rajawat M, Rastogi S, Phulware RH, Mezencev R. Leiomyosarcoma of the stomach with metastasis to the liver: a case report with review of the literature. Future Sci OA.;4(2):FSO264.
  7. [7] Rastogi S, Kalra K, Manasa P, Rajawat M, Mehta V. Long lasting response of trabectedin in patient with gastric leiomyosarcoma with liver metastasis: an update to previous report. Future Sci OA. 2019;6(1):FSO432.
  8. [8] Ravacci GR, Ishida R, Torrinhas RS, Sala P, Machado NM, Fonseca DC, et al. Potential premalignant status of gastric portion excluded after Roux en-Y gastric bypass in obese women: A pilot study. Sci Rep. 2019;9(1):5582.