[Giant epithelioid leiomyosarcoma of the stomach]

Epithelioid leiomyosarcoma of the stomach is an uncommon tumour, predominantly in old persons. The majority of tumours are small, giant tumours are rare. A tumour is more frequent in the upper part of the stomach. It rarely gives secondary deposits, almost only large ones. In a few big published series of patients, secondary deposit were not found in lymph nodes or other organs. Gastrointestinal bleeding, easy fatigue and pain are the usual symptoms of the disease. Endoscopic and fine needle biopsy was successful in single cases. A limited wedge gastric resection is considered as one of the most appropriate surgical treatments. Major resections are reserved for giant tumours infiltrating surrounding organs, and for recurrencies. Due to rare involvement of lymph nodes, systematic lymph node dissection is not regarded as a necessary procedure. The recurrencies can be successfully removed in a number of cases. Chemo- and radiotherapy are generally regarded as useless. We present a 61-year old male patient who had discomfort in the upper abdomen. CT scan was performed but radiologist missed to diagnose an obvious mass in the upper mid-abdomen. Three years later he came with high temperature and leukocytosis. The preoperative examination showed conflicting results, ultrasonography that the tumour did not belong to the liver but CT scan showed that the tumour arose from the left lobe of the liver. Barium swallow showed signs of external pressure on the stomach from the right toward left and downwards. During the operation, a giant gastric tumour (215 x 139 x 135 mm) originating in the antral part of the small gastric curvature was removed with distal 2/3 of the stomach. Histologic examination showed epithelioid leiomyosarcoma of the stomach with umbilical ulceration. About 50% of the tumour was necrotic. There were no lymph node deposits. Temperature and WBC count dropped to the normal value soon after surgery. The patient stayed symptom-free so far, five months after the operation.