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Image of the month answer
March 2002
CORRESPONDENCE
843
Image of the Month Answer: Leiomysarcoma Answer to the Image of the Month Question (page 605): The initial impression was a malignancy of the stomach, which had perforated and formed a large perigastric collection. This corresponded to the computerized tomography findings. The histology at endoscopy and the subsequent laparotomy identified it as a leiomyosarcoma of the stomach. The whole mass was a tumor, which measured 22 cm extending from the left diaphragm to the pelvis with a small intraluminal bulging component in the stomach. Leiomyosarcomas are nowadays classified as gastrointestinal stromal tumors because these are of questionable histogenesis, inconsistent immunohistochemical findings and heterogeneity. These mesenchymal tumors commonly affect men, and they present with both intraluminal and outward bulging components. Histology usually reveals a spindle cell pattern. These tumors can arise from any part of the gastrointestinal tract, but more commonly do so from the stomach (50%). Local radical removal is the favored treatment for such tumors so far. They are found to be resistant to most standard chemotherapeutic agents. Prognosis of these rare tumors depends on tumor size and histologic grade. To conclude, one has to think of the possibility of such stromal tumors whenever such voluminous intraluminal bulging tumors are seen during endoscopy. For submission instructions, please see the Gastroenterology website (http://www.gastrojournal.org).
CORRESPONDENCE
843
Image of the Month Answer: Leiomysarcoma Answer to the Image of the Month Question (page 605): The initial impression was a malignancy of the stomach, which had perforated and formed a large perigastric collection. This corresponded to the computerized tomography findings. The histology at endoscopy and the subsequent laparotomy identified it as a leiomyosarcoma of the stomach. The whole mass was a tumor, which measured 22 cm extending from the left diaphragm to the pelvis with a small intraluminal bulging component in the stomach. Leiomyosarcomas are nowadays classified as gastrointestinal stromal tumors because these are of questionable histogenesis, inconsistent immunohistochemical findings and heterogeneity. These mesenchymal tumors commonly affect men, and they present with both intraluminal and outward bulging components. Histology usually reveals a spindle cell pattern. These tumors can arise from any part of the gastrointestinal tract, but more commonly do so from the stomach (50%). Local radical removal is the favored treatment for such tumors so far. They are found to be resistant to most standard chemotherapeutic agents. Prognosis of these rare tumors depends on tumor size and histologic grade. To conclude, one has to think of the possibility of such stromal tumors whenever such voluminous intraluminal bulging tumors are seen during endoscopy. For submission instructions, please see the Gastroenterology website (http://www.gastrojournal.org).