gastric leiomyoma

Gastric leiomyomas are rare benign mesenchymal tumors, usually asymptomatic and found incidentally.

Clinical presentation

Most leiomyomas are found incidentally in asymptomatic patients. Symptoms related to a gastric leiomyoma will depend on the tumor size, location, and presence/absence of ulcerations.

Larger tumors are more prone to have associated ulcerations and thus cause bleeding, which can manifest clinically as hematemesis, melena, and iron-deficiency anemia. Epigastric discomfort or pain has also been reported in those symptomatic patients .

Pathology

Gastric leiomyomas are tumors of moderate cellularity that originate from the muscular propria or lamina muscularis mucosae of the stomach. They are characterized by bundles of spindle cells with eosinophilic cytoplasm . Although most tumors have an endoluminal growth, two other patterns have been described:  intramural/mixed (dumbbell-shaped) and exophytic .

Immunohistochemistry

Gastric leiomyomas are negative for c-kit and CD34, cf. GIST which is positive for both . Leiomyomas are positive for desmin and smooth muscle actin .

Radiographic features

CT

It usually presents as a well-defined solid mass with smooth contours and showing low homogeneous contrast enhancement . Calcifications, intratumoral hemorrhage, and cystic degeneration are rare .

Complications 

Complications are rare and may include

  • hemorrhage (hematemesis, melena)
  • obstruction 
  • fistulisation / perforation
  • malignant degeneration (exceptional)

Differential diagnosis

Consider:

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