PMC6875344_01
Preoperative imaging findings. Abdominal ultrasonography (AUS) showing a leaf-shaped tumor (arrowhead) with a mosaic pattern. (a) Computed tomography (CT) showing internal heterogeneity (arrowhead) between the head portion of the pancreas and the left liver lobe, (b) upper gastrointestinal endoscopy showing an elevated, nonepithelial lesion with a smooth surface in the lesser curvature of the stomach (arrow), (c) endoscopic ultrasonography (EUS) showing the same tumor (arrowhead) that seemed to be continuous with the fourth layer, and (d) the tumor was approximately 49 x 29 mm2 in size. The tumor mass appeared to protrude from the stomach wall.
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However, following abdominal ultrasonography (AUS) (Figure 1(a)), computed tomography (CT) (Figure 1(b)), and upper gastrointestinal endoscopy, a 4.5 cm submucosal tumor at the lesser curvature of the stomach was highly suspected. Upper gastrointestinal endoscopy showed an elevated, nonepithelial lesion with a smooth surface in the lesser curvature of the stomach (Figure 1(c)). Moreover, endoscopic ultrasonography (EUS) (Figure 1(d)) showed that the same tumor seemed to be continuous with the fourth layer, and contrast-enhanced CT revealed that the heterogeneous parenchyma was located between the head portion of the pancreas and the left liver lobe. The tumor mass appeared to protrude from the stomach wall (Figures 1(a)-1(d)).
Operative findings and macrospecimen. As the lesser omentum and fat around the tumor (arrow) were exfoliated, the tumor appeared to be continuous with only a portion of the stomach wall (a). Histopathologic examination revealed a tumor with a multinodular but smooth outer surface and foci of fleshy and pale cream-yellow areas underneath. The excised specimen after application with formalin (b) and the cut surface of the resected specimen (c), and pathological findings showed that the tumor (T) was not continuous with the stomach serosa (arrowhead) (d).
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The tumor, as well as a portion of the stomach, was completely resected, including the stomach wall believed to be continuous with the tumor (Figure 2(a)). Histopathologic examination of the tumor revealed a multinodular but smooth outer surface and foci of fleshy and pale cream-yellow areas underneath (Figures 2(b) and 2(c)). Pathological findings showed that the tumor was not continuous with the stomach serosa (Figure 2(d)).
Microscopic examination. Microscopic examination confirmed the diagnosis of leiomyosarcoma with long intersecting fascicles of spindle cells (hematoxylin and eosin staining) (a). Immunohistochemical staining revealed that the tumor was negative for c-kit (b), CD34 (c), S-100 (d), and DOG1 and positive for alpha-SMA (e), desmin (f), HHF-35, h-caldesmon, and calponin.
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Moreover, microscopic examination revealed long intersecting fascicles of spindle cells (hematoxylin and eosin staining), confirming the diagnosis of leiomyosarcoma (Figure 3(a)).