PMC9458270_01
Computed tomography with intravenous and oral contrast. Axial (A), parasagital (B) and coronal (C) planes showing a highly-vascularized tumor with an endophytic growth in the upper gastric body measuring 90 x 89 x 70 mm.
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A computed tomography (CT) scan was performed, showing a highly vascularised tumour with an endophytic growth in the upper gastric body measuring 90 x 89 x 70 mm (Figure 1).
Gastric tumor. Endoscopic and laparoscopic view. A & B) Endoscopic view of the submucosal tumor located in the greater curvature of the upper gastric body. C & D) Laparoscopic view of the tumor after performing the gastrotomy.
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Thereafter, and upper endoscopic ultrasound (EUS) was performed, evidencing a hypoecoic lesion of 60 x 58 mm with well-defined borders (Figure 2a and b).
Gastric leiomyosarcoma, Macroscopic and microscopic examination. A) Surgical specimen of a solid polypoid mass measuring 11 x 9 cm. B) Histological sections (H&E) of normal gastric mucosa with underlying neoplastic proliferation of spindle cells. C). The tumour is composed of interlacing fascicles of spindle cells, with elongated blunt-ended nuclei and eosinophilic cytoplasms. D) Some areas of the neoplasia showed marked atypia and a myxoid background. E and F) Immunohistochemical techniques. Positivity with smooth muscle actin (E) and specific muscle actin (F). Original magnification: 40x (B); 100x (C); 400x (D-F).
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All these findings were in accordance with a spindle cell tumour with smooth muscle differentiation (Figure 3). Macroscopic examination of the specimen showed an 11 x 9 x 5 cm solid endophytic mass covered with eroded mucosa compromising the gastric wall (Figure 3a). Microscopic examination showed neoplastic proliferation of spindle cells arranged in fascicles, some of them marked with atypia and areas of myxoid background (Figure 3).