Prior to 1998, gastrointestinal stromal tumors (GIST) were misdiagnosed as LMS due to lack of molecular markers. Since then there are only 10 reported cases of gastric leiomyosarcoma in the post-GIST era. On CT imaging LMS tends to show up as irregular central zones of low attenuation suggestive of extensive necrosis or hemorrhage. Endoscopically, LMS tends to appear mainly in the muscularis propria with increased vascularity and a heterogeneous appearance. For tumors greater than 2 cm surgical resection is the preferred method of treatment. For metastatic disease, however, there has been no clear benefit of adjuvant chemotherapy as there is a high risk of recurrence. Routine follow up for completely resected tumors consists of abdominal and pelvic imaging which should occur every three to six months for two to three years, and then annually. In conclusion, we highlight a rare case of an aggressive type of Leiomyosarcoma at the GE junction presenting as an upper GI bleed.[2602] Figure 1. (1) Upper Endoscopy showing mass lesion at the gastroesophageal (GE) junction. (2) Axial computed tomography (CT) image showing mass lesion in the gastric cardia (3) Spindle cells with marked atypia, necrosis, rare mitosis and moderate pleomorphism (H and E, x20) S2603
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