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:
- gastrointestinal stromal tumor (GIST)
- main differential diagnosis to consider on imaging
- heterogeneous attenuation and enhancement due to central areas of necrosis, hemorrhage, or cystic degeneration
- gastric schwannoma
- gastric lipoma
Siehe auch:
- Adenokarzinom des Magens
- Magenneoplasien
- Gastrointestinaler Stromatumor
- Lipom des Magens
- verkalktes Leiomyom des Magens
- benigne Tumoren des Magens
und weiter:
Assoziationen und Differentialdiagnosen zu Leiomyom des Magens:
