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Laparoscopy has added a new perspective to the diagnosis and treatment of abdominopelvic disease. A wide variety of gastric procedures have been completed with laparoscopy in the past several years. The authors here present successful resection of a submucosal gastric leiomyoma laparoscopically with the combined use of intraoperative gastroscopy for localization. A 2.5 x 2.0 cm submucosal gastric nodule is resected with ample margins laparoscopically. Intraoperative endoscopy is used for accurate localization because the lesion was not visible to the laparoscope on the serosal surface of the organ. Laparoscopic surgery can be applied to the traditional surgical principles with equal efficacy in selected patients.

Calcification in gastric leiomyoma (GLM) is extremely rare. Eleven cases have been reported so far, all in adults. We report the first ossified GLM in a 2-year-old child. A number of unusual clinical and imaging features are discussed.

A 42 year-old female who was otherwise healthy presented with several weeks of intermittent dysphagia for solids. One evening, she developed a food bolus while eating meat and subsequently underwent an esophagogastroduodenoscopy (EGD) for a suspected food bolus impaction of the distal esophagus. On endoscopy, the distal esophagus appeared narrowed at the level of the GE junction. No distinct stricture was identified. In the stomach, there was a 1 to 1.5 cm submucosal mass along the greater curve of the stomach. A referral was made to our facility for an endoscopic ultrasound (EUS) to evaluate the submucosal mass in the stomach. The EUS was performed using an Olympus radial echoendoscope. The submucosal lesion was identified in the fundus, along the greater curve of the stomach. On endoscopic ultrasound, the lesion appeared homogeneous, round, and well circumscribed. It measured 9.9 mm by 23.2 mm. The impression of the endosonographer was that it was a benign lesion, most likely a leiomyoma. A CT scan was recommended in 4–6 weeks. Two months later, a CT scan was obtained. The CT scan showed a 7 cm gastric mass in the area of the gastric fundus. The pancreas was not well seen. With the apparent increase in size of this tumor over such a short period, there was concern for a possible malignancy. The patient was taken to the operating room for an exploratory laparotomy and excision of the gastric submucosal tumor. During the operation, there appeared to be a densely adherent gastric mass. She underwent a wedge resection of the proximal fundus. Under microscopic examination, the mass was identified as a nodule of accessory spleen. The accessory spleen is a common congenital abnormality present in about 10% or more of the population. In our experience of over 500 EUS cases over the last three years this is the first case of an accessory spleen being identified. If our experience is representative of other institutions, experienced endosonographers are likely not seeing or not recognizing this common splenic abnormality. Reasons for this apparent underreporting could be the lack of well-defined EUS criteria for diagnosing this entity as well as its usually small size and benign appearance. We contend that the endosonographer should have a heightened awareness for this anomaly, particularly when examining the left upper quadrant.

Laparoscopic intragastric resection of gastric leiomyoma was performed using needlescopic instruments. The patient was a 71-year-old man who had a 2-year history of gastric submucosal tumor 2 cm in diameter located near the esophagocardiac junction. After getting informed consent, we performed a laparoscopic intragastric tumor resection under an oral endoscope. There were no intra- or postoperative complications. The patient was discharged uneventfully. Histopathologic diagnosis of the tumor was leiomyoma. Laparoscopic intragastric resection of a benign gastric submucosal tumor using needlescopic instruments is technically feasible and as safe as a less invasive procedure.

The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.

A gastric leiomyoma was first detected as a mass protruding into the superior aspect of the stomach bubble on a chest roentgenogram. Further evaluation of this finding proceeded despite an outside upp

Summary Five patients with smooth muscle tumours of the stomach are presented. In 3 cases, histological identification of the lesion was made pre-operatively on biopsy material obtained under direct vision at gastroscopy.

A 36-year-old man visited our hospital with a complaint of dysphoria of the epigastrium. A torous lesion was observed in the cardia by esophagogastric fluoroscopy. The patient was diagnosed as having submucosal tumor by endoscopic and biopsy examinations, and transgastric excision of the tumor nucleus was undertaken. The tumor was oval-shaped (ca. 5.5cm in a long diameter), white and solid. The histopathological findings indicated benign leiomyoma. The course was favorable two years after operation. Only 28 cases of leiomyoma in the esophagocardiac junction have been reported in Japan. Cases of leiomyoma in the esophagocardiac junction were compared with those in the esophagus and stomach. The most common age of occurrence for leiomyoma in the esophagocardiac junction was relatively young, 30s to 40s, similar to that of lesiomyoma in the esophagus. Chief complaints on admission to hospital also resembled those in esophageal leiomyoma: disturbed deglutition, epigastralgia and subclinical condition. These chief complaints were clearly different from those in gastric leiomyoma, i.e., hemorrhagic symptoms, unidentified clinical epigastric condition and abdominal mass. Leiomyoma in the esophagocardiac junction, esophageal leiomyoma and gastric leiomyoma showed different patterns of tumor development, and preoperative diagnosis is difficult in all cases. Unless specific circumstances (a markedly large tumor suspected of being malignant, full peripheral development of a tumor, or the presence of a serious complication) are present, excision of the tumor nucleus should be carried out as the first choice treatment.

During 1980 and through 1985, a total of three adult patients with adrenal cortical carcinoma were patients at the University of Mississippi Medical Center. All three of these patients with large tumors were evaluated with CT abdominal scans. The CT findings are described in each case. One patient had the unique findings of four separate tumors at the left upper quadrant, i.e. an adrenal cortical carcinoma, an ipsilateral renal cell carcinoma, an adjacent para-aortic neurofibroma, and a gastric leiomyoma. The only known cure for adrenal cortical carcinoma is complete excision. CT scanning should be utilized in all cases for diagnosis, for characterizing the tumor, for showing the presence of metastatic disease, for determining the overall extent of disease, and for determining the relationship to other organs. CT should be utilized in the follow-up with these patients after treatment, i.e. surgery and/or chemotherapy.

In order to reveal the histogenesis of leiomyoma which may arise from the muscle layar of the stomach, a histological study was carried out on 32 leiomyomas out of 30 cases obtained at autopsy in Tokyo Geriatric Hospital (1958-1969) and surgical specimens in Gunma University Hospital (1958-1977). There were 17 males and 13 females in this series. All sections were stained by Haematoxylin and Eosin and Mallory Azan. In addition Van Geison, silver stain and S-100 protein stain were also used if necessary.In this series, minute leiomyomas under 5 mm in diameter were in 11 cases (34.3%). The relationthips between the location of minute leiomyomas and growth types were discussed. Results of this study were as follows :1) Eighty per cent of leiomyomas of the stomach was located at upper third portion of the stomach as the exogastric type.2) The smaller the size of gastric leiomyoma, the higher the incidence of exogastric type at fundus of the stomach.3) Eighty two per cent of minute leiomyomas was assumed to be originated from the external muscle layer. 45 per cent of leiomyomas might grow outard and 36 per cent of them might be situated as the intramural type.

The cytological findings in 7 cases of leiomyoma and 4 cases of leiomyosarcoma can be summarized as follows: For differential diagnosis of these lesions, in comparison with leiomyoma cells, leiomyosarcoma cells were found to have 1) increased minor axis diameters of the nuclei and nuclear anisokaryosis, 2) dark nuclear staining, 3) enlarged and darkly stained chromocenters, 4) dark staining and thickening of the nuclear rim, 5) enlargement of nuclear clear areas, 6) increased numbers of oval nuclei and greater pleomorphism, 7) an increase in size and number of the nucleoli, 8) a strong tendency for cell atypism, such as anisocytosis and pleomorphism. In the light of these findings, it is believed that differential diagnosis is indeed possible.

Article, 信州医学雑誌 28(5): 546-554(1980)

The indications for subtotal gastrectomy are discussed and illustrations shown of some of the conditions and methods of dealing with them in cases of peptic ulcer, gastric, duodenal and jejunal ulcer, gastrojejunocolic fistula, gastric diverticula, ulcerating lesions of the greater curvature, carcinoma of the gastric cardia and lower end of the esophagus, and of gastric leiomyomas. The proved value of total gastrectomy in cases of cancer of the stomach is mentioned.

A case report of the successful removal of a gastric leiomyoma weighing 6 pounds (2,727 gm.) is presented. The patient had been closed as inoperable on her first surgical admission but the tumor was removed when the patient returned one month later with massive hematemesis. Resection of the tumor was mandatory as a life-saving procedure at that time. The tumor is one of the largest pure gastric leiomyomas recorded in medical literature.

The purpose of this communication is to present a case of large leiomyoma of the stomach containing extensive calcium deposits easily visible on the roentgenogram. Mention has been made (1, 3, 4) of the frequent occurrence of microscopic calcification in leiomyomata of the stomach, particularly in the central portions of the mass, and it would seem that more of these tumors should produce calcium sufficient for roentgenographic visualization. Actually, however, grossly calcified gastric leiomyomata are exceedingly rare. A review of more than fifty articles on smooth-muscle tumors of the stomach revealed a single case similar to the one to be recorded here, that of Heitz (2), reported in 1902. His description (in part) follows: “The tumor lies in the posterior wall .... It is adjacent to the middle of the lesser curvature and it raises up the serosa over the posterior side of the lesser curvature behind the gastro-hepatic ligament in the lesser peritoneal sac. It produced no elevation into the interior of ...

Summary A case report of a calcified gastric leiomyoma with gastroscopic findings is presented.

The roentgen findings of polypoid gastric tumors including those that prolapse into the duodenum are discussed and illustrated. Three patients presented characteristic roentgen appearances of prolapse. One of these tumors was a dumbbell-shaped leiomyoma that arose in the omental sac and extended into the stomach. No other case has been reported in the literature of a dumbbell-shaped gastric leiomyoma whose intragastric component herniated into the duodenum.

El leiomioma gástrico es un tumor intramural, extramucoso, localizado, en la mayoría de los casos, en el tubo digestivo superior, a nivel del tercio distal del esófago y porción superior del estómago. Puede afectar ambos sexos, pero es muy raro en la edad pediátrica. Aumenta su incidencia a partir de la quinta y sexta década de la vida, y son de tamaño variable. Se presenta el caso de un paciente masculino, de 10 años de edad, blanco, con un leiomioma a nivel de la pared gástrica, que fue resuelto quirúrgicamente con resección completa de la masa tumoral que comprometía gran parte de la curvatura mayor gástrica mediante laparotomía, pero el diagnóstico inicial y toma de biopsia se realizó por vía endoscópica.

A case of an ulcerated, bleeding gastric leiomyoma is presented in which a follow-up UGI examination showed no evidence of residual ulceration within the tumor. Radiologists should be aware that it is occasionally possible to document complete healing of ulceration within a gastric leiomyoma and that conservative medical management may be an alternative when surgical resection cannot be performed.

A 62 year-old man was admitted with the chief complaint of a epigastric pain and difficulty of swallowing. Examination of the upper gastrointestinal tract revealed a calcified mass causing a smooth filling defect at the lesser curvature of the cardia. At laparotomy, a localized tumor was detected beneath the serosa of the stomach. The excised tumor was 4 x 4 x 1.6 cm and the pathological diagnosis was calcified leiomyoma probably due to cytoplasmic degeneration. In this paper, details of the case are described and the related literature is reviewed.

A case is reported of intraperitoneal haemorrhage arising from a gastric leiomyoma. This is a rare manifestation of this tumour which usually presents with perforation, ulceration, or obstruction.

Multiple endocrine neoplasia in a 70-year-old woman are described. The findings include a nonfunctioning pituitary adenoma, a multicentric papillary thyroid carcinoma, bilateral carotid body paragangliomas, parathyroid hyperplasia, gastric leiomyoma and systemic amyloidosis. A study of the kindred revealed that two family members, a daughter and a granddaughter, have clinical and radiographic evidence of pituitary tumors and bilateral carotid body paragangliomas, suggesting that this may represent a genetically determined syndrome inherited as an autosomal dominant.

A giant smooth muscle tumour of the stomach was excised in a 58-year-old man. Although small leiomyomas are not rare, the giant gastric leiomyoma is not common, and may present diagnostic and operative difficulties. It is an essentially benign tumour, unlike the "bizarre" leiomyoma or leiomyoblastoma.

Tc-99m labeled RBC imaging is becoming increasingly useful in detecting gastrointestinal (GI) bleeding sites. A patient is presented who had massive GI bleeding from an unsuspected gastric leiomyoma in whom a Tc-99m sulfur colloid GI bleed image was negative. The Tc-99m labeled RBC imaging done on the day after sulfur colloid imaging revealed increased gastric activity due to active bleeding from an intragastric leiomyoma. Tc-99m labeled RBC imaging helped in early detection of the bleeding site resulting in its successful treatment. This experience also reinforces the assertion that Tc-99m labeled RBC imaging may be more helpful than Tc-99m sulfur colloid imaging in patients with upper GI or intermittent bleeding.

Sixteen patients with leiomyoma of the gastrointestinal tract underwent operation and removal of their tumor during a four- and one-half-year period from January 1980 to July 1984. There were three esophageal, five gastric, two small bowel, four colon, and two anorectal leiomyomas. The majority of gastric leiomyomas presented with bleeding, as did half of the small bowel and colon cases. All were treated by excision without mortality. The various clinical presentations, evaluations, and choice of operative approach for this uncommon tumor are discussed.

Small gastric smooth muscle tumors are common in adults at autopsy. Meissner in 19441 observed them in almost 50% of such cases by careful manual examination of the stomach wall. More recently, microleiomyomas of 5 mm or less diameter were detected in 16.4% of resected stomachs, mostly in the upper half.2 Thus, the larger leiomyomatous tumors of the stomach must, in current parlance, be suspected of possessing increased receptor activity for certain undefined growth factors. Platelet- xderived growth factor (PDGF), a smooth muscle growth stimulant, might be involved.3 Estrogens, of course, stimulate uterine leiomyoma growth, which ceases in their absence, but estrogens do not appear to affect similar gastric tumors that are equally common in men and women. Clinically, gastric smooth muscle tumors, benign or malignant, are asymptomatic when small unless they ulcerate and bleed. Larger solid intramural stomach tumors are spheroidal and may bulge into the lumen, stretch the serosa, or both. The classic radiologic and endoscopic appearance of gastric leiomyoma or leiomyosarcoma is a protrusive hemispherical mass in the fundus or body of the stomach, which stretches the mucosa and has an apical central volcano-like cratered ulcer that bleeds.

Immunohistochemical study of smooth muscle myosin, a protein distinct from skeletal, cardiac, or nonmyogenous myosins in paraffin-embedded normal tissues and benign and malignant mesenchymal tumors revealed its strong expression in normal smooth muscle, capillary endothelium, and pericytes. All benign smooth muscle tumors with exception of gastric leiomyomas and few other leiomyomas of the gastrointestinal tract displayed strong or moderate immunoreactivity. On the other hand, strong or moderate immunoreactivity was detected in only eight of 28 spindle-cell leiomyosarcomas, as well as in 13 out of 27 malignant fibrous histiocytomas and three out of nine malignant hemangiopericytomas, while epithelioid leiomyosarcomas, fibrosarcomas, malignant schwannomas, and synovial sarcomas were negative or only weakly positive. Our results demonstrate that, while smooth muscle myosin is a very good marker of normal smooth muscle and benign smooth muscle tumors, it is expressed in diagnostically significant amounts in less than a third of spindle-cell leiomyosarcomas and none of the studied epithelioid leiomyosarcomas.

Gastric leiomyoma in childhood is excessively rare. Leiomyomata represent only 1 per cent of all gastro-intestinal neoplasms reported (Huntley, Laurain and Stephenson, 1960), and slightly more than half of these are gastric (Golden and Stout, 1941). In a very extensive review of the world literature up to 1960, Skandalakis, Gray and Shepard (1960) collected 1,223 cases of which 84 per cent were within the ages of 30–70 years; only four were in the paediatric age group. The youngest case reported was an African male child of two years (Golden and Stout, 1941). A child of 11 years of age was reported by Mayson and Sieber (1967).

Leiomyomatous calcification within a mediastinal mass shown on a barium swallow examination to be partly endogastric within a large hiatal hernia suggested the preoperative diagnosis of calcified gastric leiomyoma.Seven previous instances of calcification within gastric leiomyomata have been reported, but this is the first case of gastric origin demonstrated within a hiatal hernia.

A patient with an extraluminal gastric leiomyoma, which presented as an emergency because of torsion, is reported. This is thought to be the first report of such an occurrence. The diagnosis was not made preoperatively in spite of intensive investigation.

A case of a large, partially calcified leiomyoma of the stomach is described. Gastric hemorrhage was the presenting symptom. Benign gastric tumors are infrequently found at operation. Calcification in a benign gastric tumor appears to be unusual and is interesting.

Among benign tumors of the stomach leiomyoma ranks second in incidence, being exceeded only by adenomatous polyps. Meissner (22) discovered 23 leiomyomas in a careful study of 50 stomachs chosen at random at autopsy. In three series of benign gastric tumors, the incidence has been reported as 36.6 per cent, 39.9 per cent, and 60 per cent, respectively (2, 3, 8). In a series of 711 gastric resections (28), leiomyomas made up 0.43 per cent of the cases. Rieniets (29) reported the incidence of gastric leiomyomas to be 16 per cent, and of gastric leiomyosarcomas 6 per cent, in 200 consecutive autopsies. Leiomyosarcomas are said to form about 10 per cent of all gastric sarcomas (31). Of 30 smooth-muscle tumors of the stomach, Golden and Stout (11) found 65 per cent to be benign and 35 per cent malignant. Accurate differentiation between leiomyoma and leiomyosarcoma by clinical observation, roentgenography, gastroscopy, or direct visualization at surgery, without histologic examination, is not always possible. ...

Background Gastric cancer is one of the most common malignant tumors in the world. Finding effective diagnostic biomarkers in urine or serum would represent the most ideal solution to detecting gastric cancer during annual physical examination. This study was to evaluate the potential of endothelial lipase (EL) as a urinary biomarker for diagnosis of gastric cancer. Methods The expression levels of EL was measured using Western blotting and immunohistochemical staining experiments on (tissue, serum, and urine) samples of gastric cancer patients versus healthy people. We also checked the EL levels in the urine samples of other cancer types (lung, colon and rectum cancers) and benign lesions (gastritis and gastric leiomyoma) to check if EL was specific to gastric cancer. Result We observed a clear separation between the EL expression levels in the urine samples of 90 gastric cancer patients and of 57 healthy volunteers. It was approximately 9.9 fold average decrease of the EL expression levels in the urine samples of gastric cancer compared to the healthy controls (P P = 0.90 and P = 0.79). In immunohistochemical experiments, positive expression of the EL protein was found in 67% (8/12) of gastric adjacent noncancerous and in 58% (7/12) of gastric cancer samples. There was no significant statistical in the expression levels of this protein between the gastric cancer and the matching noncancerous tissues (P =0.67). Conclusions The urinary EL as a highly accurate gastric cancer biomarker that is potentially applicable to the general screening with high sensitivity and specificity. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4527331618757552

Gastric leiomyoma is a rare gastric neoplasia. The laparoscopic method may treat various gastric tumors, including benign leiomyoma by wedge resection without opening the gastric cavity. The laparoscopic approach to submucosal tumors of the stomach is technically feasible, is safe, and has good postoperative results. It should be considered a viable alternative to open surgery. Herein, we describe a case of laparoscopic wedge resection of gastric leiomyoma.

Benign tumors of the stomach of a non-epithelial nature are rare diseases and do not exceed 3.6-5% of the total number of neoplasms of this organ.

A case of a gastric leiomyoma in an 11 year old boy is reported. The symptoms, signs, and roentgenographic findings are reviewed. It is hoped that cognizance of these will make a correct preoperative diagnosis likely.

Carcinoid tumor of the stomach is a relatively rare lesion. There have been 42 documented cases reported in the literature, but 16 of these were incidental findings at necropsy examination. There have been no reported cases diagnosed preoperatively. In a recent study, pathological diagnosis of stomach lesions over a 20-year period are reviewed. 1 In this series were 1,235 cases of gastric carcinoma, 38 gastric leiomyomas, and 5 gastric carcinoids. There is apparently no sex-linked incidence, since 19 of the reported cases occurred in males and 21 in females. (The other was not reported.) The youngest instance occurred in a 15-year-old girl and the eldest in an 89-year-old man. The average age of all of the cases, excluding those found incidentally at necropsy, is 48years. 1 In contrast, the average age at the time of diagnosis of appendiceal carcinoids is 29 years and small intestinal carcinoids, 57 years. 1 Gastric carcinoids