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Malignant transformation of gastric leiomyoma has not been reported, and therefore it is considered to have virtually no malignant potential. We report a case of gastric leiomyosarcoma arising from leiomyoma. The patient is a 72-year-old man with a submucosal mass measuring 20 mm in diameter, which was incidentally identified by an endoscopic surveillance. A biopsy suggested a diagnosis of leiomyosarcoma, and local excision was performed. Pathological examination revealed that the tumor was composed of two distinct components: typical leiomyoma-like area in the periphery and leiomyosarcoma component exhibiting higher cellularity, prominent nuclear atypia, necrosis, and increased mitosis. Immunohistochemically, in the latter, p53 overexpression, increased Ki-67 labeling index, and attenuated expression of smooth muscle markers were noted. This is the first report to demonstrate the presence of leiomyoma-leiomyosarcoma sequence in the stomach that is well recognized in the uterus. Our observation highlights the potential occurrence of malignant transformation of gastrointestinal leiomyoma.

Gastrointestinal leiomyomas often occur in the esophagus, colon, and rectum, but are very rare in the stomach. The patient was referred to Jeju national university medical center for the treatment of a left adrenal tumor diagnosed 5 years ago. She had a long history of repeated left flank pain, nausea, and abdominal distension for the last few years. Annual follow-up computed tomography scan showed a no changed 5×5.5-cm sized multiloculated left adrenal cystic lesion. Laboratory tests revealed that the basal levels of plasma adrenocorticotropin, cortisol, aldosterone, renin, testosterone, adrenaline, noradrenaline, and dopamine were normal findings. The preoperative diagnosis was a left nonfunctioning adrenal neoplasm with symptom of discomfort. However, the tumor revealed as an exophytic growing leiomyoma with cystic changes of a stomach by surgery. The mass was found at the posterior wall of the fundus and about 5-cm-sized mass. Resection of the tumor was performed using laparoscopy. The pathologic diagnosis revealed a gastrointestinal leiomyoma with a benign cystic lesion lined by respiratory epithelium with an old hemorrhage and chronic gastritis. The patient had no evidence of recurrence during the 12-month follow-up. Gastric leiomyoma is unfamiliar to the usual urologists. It needs to take gastric leiomyoma into account if the left adrenal tumor is close to the stomach. Herein, we report the case of a 44-year-old woman with gastrointestinal leiomyoma misdiagnosing as a nonfunctioning adrenal tumor.

Leiomas are more common in men aged 20 to 50 years. In women, they occur at an older age and 3 times less often than in men. An essential point in the disease pathogenesis is rapid growth of leiomyomas and their tendency to ulceration with decay, which leads to the development of formidable complications in the form of bleeding, perforation of the hollow organ, followed by the development of peritonitis. The growth of leiomyomas occurs from the thickness of the muscle layer in the form of a single node, mainly endogastrically in 66.5 % of cases. Exogastric growth was noted in 24.6 %, mixed in 5 % and intramural in 3.9 % of cases. A rare representation of benign stomach tumors of non-epithelial origin is characterized by an extremely wide variety of their types and names. A clinical case of surgical treatment of gastric leiomyoma using minimally invasive technologies in a patient with concomitant pathology is presented. The neoplasm was detected during a screening examination of the respiratory system. The patient underwent laparoscopic removal of the neoplasm. A macro- and micropreparation of gastric leiomyoma is presented. After surgical treatment, a positive result was achieved, the patient was discharged from the clinic in a satisfactory condition. The modern development of medicine and the use of video endoscopic technologies significantly expand the possibilities of surgery for neoplasms of the gastrointestinal tract. This observation demonstrates the features of the clinical picture of benign gastric neoplasms and the possibility of using minimally invasive surgical technologies in their treatment against the background of severe comorbid pathology.

Aim. To identify criteria for differential diagnosis between gastrointestinal stromal tumor (GIST) and gastric leiomyoma (GLe) in contrast-enhanced computed tomography (CECT).Material and methods. We retrospectively analyzed CECT data of 65 patients with GIST and 19 patients with GLe. All cases were histologically and immunohistochemically proved. We evaluated tumor size, contours, growth type, extraorgan extension, invasion into the surrounding tissues, tumor calcification/ulceration/necrosis and regional lymph node status.Results. Among 84 patients divided into two groups (65 patients with GIST and 19 with GLe, respectively) we found that tumor localization, heterogeneous enhancement, and intratumoral necrosis may be utilized for differential diagnosis. The prognostic value significantly increased with the use of relative density ratio (tumor density/ aorta density or tumor density/portal vein density in the arterial, venous, and delayed phases, respectively) compared to tumor density alone. It was found that malignant GISTs are characterized by a higher relative density ratio than leiomyomas in the venous phase.Conclusion. We developed a prognostic model for differential diagnosis between GIST and GLe with a sensitivity of 90.8% and specificity of 89.5%. We created an online calculator that preoperatively determines probable tumor type (http://medstatistic.ru/giso.html).

Endoluminal gastric leiomyoma (GL) of the antrum is a rare benign tumor. In this paper, we report a case of a 72-year-old patient that presented for a 1-month episode of epigastric pain. Imaging found a well-limited tumor in the antrum with extrinsic compression on ulcerated congestive mucosa. A surgical resection based on Finsterer's antrectomy with end-to-side trans-mesocolic gastro-jejunal anastomosis was performed. The histopathological examination in combination with immunohistochemistry diagnosed GL and found a diffuse and marked staining of smooth muscle actin (SMA) and h-caldesmon (h-CD) and negative expression of CD117 and DOG1. The patient was discharged without post-surgical complications and is still alive at the time of this case report writing.

BACKGROUND Gastric leiomyomas and gastric stromal tumors are the most common types of gastric tumors encountered. In recent years, the incidence of the two types of tumors has been increasing, but the differential diagnosis is still a challenge in clinical work. However, as there are many reports on stromal tumors and inflammation-related indicators are gradually being paid attention to as important factors in predicting tumor prognosis, the two main purposes of this study were to explore the inflammation-related differences between the two types of tumors and to develop a nomogram as a predictive model. AIM To explore the differences in platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), lymphocyte mononuclear cell ratio (LMR), and SII between the two types of tumors, and simultaneously create the nomogram model. METHODS This study enrolled 88 patients in the gastric stromal tumor group and 56 patients in the gastric leiomyoma group, and the relevant data of the two groups were entered into the system for an integrated analysis. The primary objective of this study was to identify the differences in the inflammation index between the two types of tumors. RESULTS There were statistically significant differences between the two groups in sex, age, and tumor location. In comparison, gastric leiomyomas seem to be more common in women, young patients, and gastric cardia, which is in line with our previous research; the groups showed the following statistical differences: PLR (158.2% vs 134.3%, P = 0.028), NLR (2.35 vs 1.68, P = 0.000), LMR (5.75 vs 10.8, P = 0.004), and SII (546.2 vs 384.3, P = 0.003). The results of the multivariate logistic regression analysis showed that sex, age, tumor location, and LMR were independent risk factors for the identification of the two types of tumors. After considering the risk factors selected by the above analysis into the predictive model, a predictive model for distinguishing gastrointestinal stromal tumors from gastric leiomyomas was established as the nomogram. CONCLUSION Gastric leiomyomas and gastric stromal tumors are not only different in factors such as age of the patient, but also in inflammatory indicators such as LMR and PLR. We have established a predictive model related to the laboratory indicators and are looking forward to further research conducted in this clinical area.

Surgery has been considered the main treatment for submucosal tumors (SMTs). However, endoscopic resection is currently accepted for gastric SMTs smaller than 3 cm. Endoscopic submucosal dissection (ESD) is considered the technique of choice, and submucosal tunneling endoscopic resection has successful results with low complication rates according to the recent meta-analysis by Cao et al. The major limitation of these methods is the technical difficulty associated with certain anatomic locations.

Los leiomiomas gastricos son tumoraciones submucosas benignas, poco comunes, que se originan del musculo liso. Clinicamente son asintomaticos, con buen pronostico y con pocas complicaciones a largo plazo. Reportamos el caso de un joven de 16 anos que se presenta a la clinica con melena y dolor abdominal. En la endoscopia se reporta una tumoracion prepilorica, ulcerada y cubierta de fibrina. El estudio histopatologico mostro una neoplasia mesenquimal con positividad inmunohistoquimica para desmina y actina, asi como negatividad para C-kit, DOG-1 y S-100, compatible con leiomioma gastrico. Fue intervenido quirurgicamente realizandose antrectomia laparoscopica con reconstruccion en Y de Roux de manera exitosa. Gastric leiomyomas are rare, benign submucosal tumors originating from smooth muscle cells. They are usually asymptomatic, having good prognosis with limited long-term complications. A 16-year-old young man comes to our clinic and reports melena and abdominal pain. Upper endoscopy revealed a prepyloric, ulcerated, fibrin-covered tumor. Histopathological examination showed a positive immunohistochemical stain mesenchymal neoplasm for desmin and muscle actin, being negative for C-kit, DOG-1 and S100 proteins, consistent with gastric leiomyoma. Antrectomy with Roux-en-Y gastrojejunostomy was successfully performed.

Purpose: To discuss significant computed tomography (CT) findings that differentiate gastric leiomyomas (GLs) from small gastric stromal tumors (GSTs). Methods: One hundred sixty cases with pathologically proven GLs (n = 50) and GSTs (n = 110) with comprehensive CT images were enrolled in this retrospective study. Computed tomography findings (ie, size, location, contour, growth pattern, enhancement degree, necrosis, ulceration, calcification, and lymph nodes) were analyzed through the χ2 or Fisher exact test, independent T test, and multivariate (logistic regression) analysis. Sensitivity and specificity were also calculated. Results: Features of cardia location, endophytic growth, homogeneous gradual enhancement, absent of necrosis, long diameter less than 24 mm, short diameter less than 20 mm, unenhanced CT value larger than 35.2 Hounsfield units (HU), portal venous phase CT value larger than 67.4 HU, and enhancement degree of arterial and venous phase less than 16.2 HU and 32.4 HU were found to be statistically significant between GLs and small GSTs ( P < .05). On multivariate analysis, cardia location, endophytic growth, and homogeneous gradual enhancement were independent predictive factors for GLs and small GSTs. Conclusion: These 10 CT criteria are very helpful to differentiate GLs from small GSTs. Especially cardia location, endophytic growth, and homogeneous gradual enhancement are of high value in differential diagnosis.

Laparoscopic sleeve gastrectomy (LSG) has gained popularity in the last 10 years for its good results in weight loss and comorbidity control. However, guidelines on the pathological examination of the specimen are lacking. The aim of this retrospective study was to determine the usefulness of the routine specimen examination when presurgery endoscopy (upper gastrointestinal endoscopy, UGIE) and multiple gastric biopsies are part of the preoperative work-up. A retrospective review of records of the patients submitted to LSG between January 2012 and August 2017 was carried out. Sex, age, histopathology findings in the presurgery endoscopy biopsies and surgical specimen, and the prevalence of Helicobacter pylori infection were analyzed. A total of 925 patients entered the study group (mean age = 44.1 years, Females = 80.3%, BMI = 44.58 kg/m2). The most common histopathology pattern in the endoscopy biopsies and in the surgical specimens was inactive chronic gastritis (64.4 and 55.6%, respectively). Helicobacter pylori infection was 24.6 and 2.48%, respectively. Ninety-nine percent (n 796) of patients with non-significant endoscopy biopsy findings showed the same patterns in specimen analysis. Only three patients (0.3%) who had intestinal presurgery metaplasia were positive in the specimen analysis, and two cases of gastric stromal neoplasms (gastrointestinal stromal tumor and gastric leiomyoma) were found intraoperatively. Most of the findings are non-significant and can be predicted if UGIE plus multiple biopsies is routinely included in the bariatric work-up with significant cost reduction. In those patients who had a significant finding prior to the surgery or intraoperatively, the pathological examination of the specimen is recommended.

Highlights • Granular cell tumors of the abdominal wall are rare. • Mesenchymal tumors may have similar findings on diagnostic imaging studies. • Laparoscopic-endoscopic cooperative surgery may useful to resect gastric submucosal tumors., Introduction Gastric leiomyomas are benign mesenchymal tumors, comprising about 2.5% of gastric neoplasms, which can be difficult to differentiate from gastrointestinal stromal tumors which have malignant potential. Granular cell tumors in the abdominal wall are also rare. Since mesenchymal tumors are difficult to diagnose by imaging, further studies are needed to establish the diagnosis. Presentation of case A 60-year-old asymptomatic woman underwent routine upper endoscopy and was found to have a gastric submucosal lesion. Computed tomography scan also showed an abdominal wall mass. The appearance of both lesions on imaging studies were similar, but it was unclear if the two lesions had the same origin. Endoscopic ultrasound-guided fine needle aspiration biopsy of the gastric lesion was insufficient to establish the diagnosis. Laparoscopic-endoscopic cooperative resection of the gastric lesion and ultrasound-guided core-needle biopsy of the abdominal wall mass enabled pathological diagnosis of both lesions. Discussion Diagnostic imaging findings of these two lesions were similar. Histologic and immunohistochemical studies are essential to establish a definitive diagnosis. Laparoscopic-endoscopic cooperative surgery may be an effective minimally invasive approach, allowing both pathological diagnosis and complete resection of a gastric submucosal tumor, especially when endoscopic-ultrasound guided fine needle aspiration or biopsy fails to make the diagnosis. Conclusion Laparoscopic-endoscopic cooperative surgery can be an effective minimally invasive approach to resect some lesions. This is first report of the patient with a synchronous gastric leiomyoma and an intramuscular granular cell tumor in the abdominal wall.

Background: Gastric neoplasia is rare, corresponding to less than 1% of cases, with a lower prevalence of those involving smooth muscle tissues. In these cases, clinical signs worsen in the occurrence of pyloric obstruction, leading to clinical manifestations such as chronic emesis. The exeresis of the neoplasm is promoted as a therapeutic measure to reestablish gastrointestinal flow. There partial gastrectomy followed by gastroduodenal anastomosis, using the Billroth I technique, is among the available surgical techniques. The therapeutic success of the Billroth I technique after pylorectomy was reported in a dog with gastric leiomyoma.Case: Canine, poodle, 9 years old, 9.5 kg, with a history of chronic vomiting starting three months ago, progressive weight loss, and melena, previously treated by another Veterinarian as idiopathic gastroenteritis. The physical evaluation of the animal showed a state of normal consciousness, body score 4/9, pale ocular and oral mucous membranes, respiratory rate 20 mpm, heart rate 166 bpm, a rectal temperature of 37.9 °C, and dehydration degree of 8.0%. Blood count showed normocytic normochromic anemia and leukocytosis with shift to the right. Radiographic and endoscopic examinations were not noteworthy. Endoscopic biopsy after a histopathological evaluation showed no cellular or tissue atypia. On the other hand, abdominal ultrasound assessment revealed thickening with loss of echotexture and definition of the muscular layer of the gastric wall, pyloric and duodenum region compatible with benign antral muscle hypertrophy and/or pyloric neoplasia. The animal worsened five days after the initial treatment, with progressive episodes of emesis and melena, opting for an exploratory laparotomy. A mass of firm consistency measuring approximately 2.5 × 6.0 cm in diameter was found in the pyloric region, opting for a pylorectomy. The excised fragment was sent for histopathological examination. Then, gastroduodenal anastomosis was performed using the Billroth I technique. After the surgery, a pasty diet was introduced orally, without using gastroenteric tubes. Dry food was offered ten days after the surgical procedure. The animal returned for clinical reevaluation on the fifteenth day and was clinically well. Histopathological examination revealed a diagnosis of gastric leiomyoma.Discussion: The casuistry of gastric neoplasia in dogs has a low incidence, with an occurrence of less than 1%, with adenocarcinoma being the most common type. However, there are less frequent reports of other gastric neoplasia, such as smooth muscle tumors. Abdominal ultrasonography is indicated for the diagnosis of gastrointestinal changes, proof of which ultrasonography was of paramount importance in this case. The surgical procedure of pylorectomy guaranteed a margin of one centimeter, meeting the principles of oncological surgery. Absorbable monofilament suture materials are the choice for the synthesis stage in hollow organs, being used in this case. The most-reported expected complications of gastrointestinal surgeries aiming at removing neoplasms are vomiting, anorexia, melena, hematochezia, hematemesis, necrosis with anastomotic ulceration, and, consequently, septic peritonitis, which were not reported in this case. The life expectancy of patients with gastric neoplasia is quite variable, with longer survival in cases of benign neoplasia. Therefore, the type of neoplasia in this case, together with the appropriate choice of therapy and the appropriate performance of the technique, was important for the good result achieved.

CASE DESCRIPTION A 4-year-old sexually intact male pet guinea pig (Cavia porcellus) was evaluated for a routine wellness examination. CLINICAL FINDINGS During physical examination, a small mass was palpated in the cranial aspect of the abdomen. Abdominal radiographic and ultrasonographic findings were suggestive of a gastric mass. Cytologic evaluation of a fine-needle aspirate of the mass was indicative of spindle cell proliferation most consistent with a sarcoma. TREATMENT AND OUTCOME The patient was anesthetized, and an exploratory laparotomy and partial gastrectomy were performed to resect the gastric mass. Histologic and immunohistochemical examinations of the mass revealed that it was a gastric leiomyoma. The patient recovered from surgery without complications. No evidence of mass recurrence was observed during an abdominal ultrasonographic examination performed approximately 19 months after surgery. CLINICAL RELEVANCE To our knowledge, this was the first report of the clinical diagnosis and successful surgical treatment of a gastric neoplasm in a guinea pig. Gastric leiomyomas are not uncommon in guinea pigs, and although benign, they can cause clinical signs if they become large enough to impair gastric function. Gastrointestinal surgery should be considered as a treatment option for guinea pigs with similar gastric neoplasms.

Gastric cancer in dogs is rare. Leiomyoma is a benign tumor that occurs most commonly in the stomach of older dogs. Its symptoms are associated with a functional disorder of the stomach flow. The best investigative tests for gastric cancer are abdominal ultrasound and endoscopy; diagnosis is based on histopathologic examination. Treatment of gastric cancer is performed by surgical resection, with a good prognosis when complete tumor excision is obtained. In this article, two cases of gastric leiomyoma are reported, both in older asymptomatic bitches where the leiomyoma was found by abdominal ultrasound. With the surgical excision of the tumors, good survival of both animals was attained.

Leiomyomas and schwannomas of the gastrointestinal tract (GIT) are mainly comprised of spindle-shaped tumor cells and should always be differentiated from gastrointestinal stromal tumors (GISTs). Mast/stem cell growth factor receptor Kit (KIT) and discovered on GIST-1 (DOG1) are well-known diagnostic markers for the detection of a GIST by immunohistochemical staining. The aim of the present study was to assess the prevalence and significance of spindle cell tumors of the GIT with KIT- or DOG1-positive spindle-shaped cells, presumed to be interstitial cells of Cajal (ICCs), other than GISTs. A total of 71 leiomyomas and 35 schwannomas were examined and clinicopathological information was obtained. KIT and DOG1 immunostaining was performed to determine the proportions of positive cells. Mutation screening of KIT exons 9, 11, 13 and 17, and platelet-derived growth factor receptor α (PDGFRA) exons 12 and 18 was performed in cases with a relatively high proportion of either KIT- or DOG1-positive cells. The frequency of leiomyomas and schwannomas with KIT- and DOG1-positive ICCs was 35.2% (25/71 cases) and 5.7% (2/35 cases), respectively. Among the esophageal leiomyomas with KIT- and DOG-positive ICCs (14/25; 56.0%), 5 leiomyomas involved the muscularis mucosa and 9 leiomyomas involved the muscularis propria. All gastric leiomyomas with KIT- and DOG1-positive ICCs (11/25; 44%) involved the muscularis propria. All schwannomas with an increased proportion of KIT- or DOG1-positive ICCs were of gastric origin. No KIT or PDGFRA mutations were detected in 7 leiomyomas and 2 schwannomas. In conclusion, the majority of leiomyomas and the minority of schwannomas in the GIT had a significant portion of KIT- and DOG1-positive cells. All of the tumors were located in the upper GIT, and could be present in the muscularis propria or muscularis mucosa. The tumors represented a non-neoplastic proliferation of KIT- and DOG1-positive cells in the GIT. Careful evaluation of KIT- or DOG1-positive cells in spindle cell tumors of the GIT can assist in forming the correct diagnosis by differentiation from a GIST.

Leiomyomas are rare, benign submucosal tumors originating from smooth muscle cells. The clinical presentation is usually asymptomatic, with excellent prognosis. We herein report the case of a 68-year-old female with a solitary leiomyoma found during esophagogastroduodenoscopy for hematemesis. Histopathological examination revealed smooth muscle proliferation supported by positive staining for smooth muscle myosin heavy chain and negative staining for CD117 and S-100, consistent with the marker expression pattern of leiomyoma. We report on the clinical presentation of this case, and discuss the origin, epidemiology, treatment and management of leiomyomas.

Background Laparoscopic sleeve gastrectomy (SG) is a well-tolerated and effective procedure for sustained weight loss and amelioration of weight-related co-morbidities. Rarely, unexpected pathology may be identified intraoperatively, which may alter the surgical plan. Gastrointestinal stromal tumors (GISTs) are among the more frequently encountered tumors and pose a particular concern because of their malignant potential. We review our findings of incidental tumors encountered during 1415 consecutive SGs. Methods Abnormal pathology records from all patients who underwent SG at our institution between 2009 and 2014 were reviewed. Patient demographic characteristics and clinical characteristics, tumor characteristics, including immunohistochemistry, operative course, and patient follow-up were reviewed. Results There were 17 incidental gastric mesenchymal tumors identified (1.2%) in 1415 SG procedures. This included 12 GISTs (.8%), 2 schwannomas (.1%), and 3 leiomyomas (.3%). In the majority of cases (1210/1415), the gastric specimens were not reviewed by a pathologist because there were no gross abnormalities appreciated by the surgeon. The GISTs were between .3 and 2.9 cm, and all were low grade with negative margins. Patients with GISTs tended to be older (mean age 55±9.3 y) than the rest of the patients. There was no evidence of recurrence on follow-up. Conclusion Incidental gastric mesenchymal tumors are rarely encountered during SG. The vast majority were GISTs with an incidence of .8% in this population. Concomitant SG and tumor resection were feasible, without compromising the objectives of each. Complete tumor excision is necessary for tumors>2 cm.

Leiomyomas constitute 2.5% of all resected neoplasms of the stomach. They are usually asymptomatic, but may present mucosal ulceration. Aberrant DNA methylation is a well-defined epigenetic change in human neoplasms; however, gene-acquired methylation may not necessarily be related with a malignant phenotype. In this report we analyzed in a gastric leiomyoma, the methylation status of 84 CpGI in tumor suppressor and DNA repair genes. We analyzed the tumor center (TC) and tumor periphery (TP) separately. We found aberrant methylation in 2/84 CpGI in the TC portion, that is, MLH1 and MSH3, and 5/84 CpGI in the TP, that is, MLH1, MSH3, APC, MSH6, and MGMT.The gene with the highest methylation percentage in the TC and TP was MLH1. Given that MLH1methylation has been associated withmicrosatellite instability, we analyzed the status of themicrosatellite Bat-26. We found that neither the TC nor the TP presented instability.The methylation of MLH1, MGMT, and APC has been described in GISTs, but to the best of our knowledge this is the first time that the methylation of these genes has been associated with gastric leiomyoma. Further research should be conducted to identify reliable molecular markers that could differentiate between GISTs and gastric leiomyomas. Fil: Branham, Maria Teresita. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; Argentina Fil: Pellicer, Monica. Laboratorio de Patología; Argentina Fil: Campoy, Emanuel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; Argentina Fil: Palma, Marcelo. Provincia de Entre Rios. Hospital San Martin; Argentina Fil: Correa, Agustín. Hospital Español; Argentina Fil: Roqué, Monica Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; Argentina

Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach.

Background: Cutaneous leiomyomatosis has been associated with multiple uterine myomas and, more recently, with germline heterozygous mutations of the FH gene and certain types of renal cancer. Despite the growing amount of knowledge concerning this genodermatosis, its clinical spectrum remains incompletely characterized. Objective: We report the observation of a patient with multiple cutaneous and uterine leiomyomatosis (MCUL) with unusual gastrointestinal manifestations. Methods and Results: A gastric leiomyoma was diagnosed on a 38-year-old female MCUL patient on endoscopy performed because of mild dyspepsia. Furthermore, routine colonoscopy disclosed hyperplastic polyposis. Genetic testing revealed a previously not reported mutation of the FH gene. Conclusion: Gastrointestinal lesions such as the present ones are frequently asymptomatic and probably underdiagnosed. As the phenotypical spectrum associated with mutations of the FH gene keeps expanding, clinicians should keep in mind that, besides renal cancer, other unexpected tumors could also arise in this setting.

Gorlin-Goltz syndrome (GGS), also known as nevoid basal cell carcinoma syndrome (MIM 109 400), is a rare genetic condition with a prevalence between 1/56 000 and 1/256 000. Clinical presentation is usually characterized by multiple basal cell carcinomas, odontogenic jaw keratocysts, palmar or plantar pitting and skeletal anomalies. It is furthermore associated with the development of various tumors beside basal cell carcinoma, among which medulloblastoma is the most frequent. Increased incidence of other mesenchymal neoplasms, however, is also well known: recently the first adult case of gastric leiomyoma in GGS was reported, and the inclusion of "fibromas and leiomyomas of other organs" in the minor criteria for the diagnosis was suggested. We report the first case of a pediatric patient with GGS who also developed a gastric leiomyoma: the present case illustrates the need for this change to the diagnostic criteria to encompass the highly variable presentations and phenotype in GGS.

Objective This study describes the computed tomographic (CT) findings of true leiomyomas in the stomach. Methods Eleven patients with histopathologically proven gastric true leiomyomas were finally enrolled. All cases were CD117 (c-kit) negative on immunohistochemical study. We retrospectively reviewed the CT findings of gastric true leiomyomas for the following considerations: location, morphological features (size, contour, tumor growth pattern, and enhancement pattern), and ancillary findings (ulceration and calcification). Results All leiomyomas were in the cardia, with an average tumor size of 36 mm (range, 13-47 mm). Computed tomography scans revealed the morphological features as follows: tumor growth pattern: intraluminal mass (n = 10) and extraluminal masses (n = 1); contour: lobulated margin (n = 7) or smooth margin (n = 4). All lesions showed homogeneous contrast enhancement. Most of the tumors showed lower enhancement than those in the liver (n = 10). One case showed ulceration but no calcification. Conclusions In conclusion, gastric leiomyomas are mainly located in the cardia and usually appeared as homogenous low attenuated masses on computed tomography.