Gastric Leiomyoma and Vitamin B12 Deficiency Anemia Combined With Opistorchiasis. A Clinical Case

Abstract

This case report demonstrates the interrelations between several clinical conditions: gastric leiomyoma, vitamin B12 deficiency anemia, and chronic opistorchiasis. A patient from diphyllobotriosis and opistorchiasis endemic territory presented with the symptoms of vitamin B12 deficiency. An endoscopic investigation found a 2 cm submucous node on the posterior wall of the stomach. Upon histological analysis, the node contained spindle-shaped cells with cigar-shaped nuclei without active mitoses and cell atypia. The immunohistochemical reaction to desmin and α-actin of smooth muscles was positive, while no CD117 and CD34 expression was found. These findings defined the node as a gastric leiomyoma. Multiple stool samples prepared with the Kato technique contained no Diphyllobothrium latum but Opistorchis felineus eggs were found. Kato method cannot rule out diphyllobotriosis completely. Simultaneously, opistorchiasis has no direct pathogenic interrelation with vitamin B12 deficiency anemia. Leiomyomas express the VPAC2 receptors. This makes the gastric glands more sensitive to the vasoactive intestinal polypeptide (VIP) that inhibits gastric secretion. Another possible mechanism that contributes to the vitamin B12 deficiency is autoimmune, where leiomyomas induce the antibodies against the Castle factor. However, the role of a combination of leiomyoma and opistorchiasis is still under discussion. Thus, this case should encourage the future research on the contribution of opistorchiasis to the onset of gastric leiomyoma.