Gastric Smooth Muscle Tumors: Diagnostic Dilemmas and Factors Affecting Outcome

Abstract

We reviewed the 46 gastric stromal tumors that were treated at our institution between 1958 and 1992. The most common presenting symptoms were gastrointestinal bleeding, pain, and fatigue or malaise. The tumors ranged from 4 to 150 mm, with surgery most often being a wedge excision or partial gastrectomy. Abdominal computed tomography was the most specific diagnostic test obtained preoperatively. Factors associated with decreased survival included size >/= 8 cm (p = 0.02), more than 0-3 mitoses per 10 HPF (p < 0. 001), positive margins or unresectability (p = 0.008), and tumor pathologic grade II or more (p = 0.004). These tumors have an unpredictable behavior. Surgical resection with negative margins remains the best therapy, but resection for palliation is sometimes indicated as it can be associated with prolonged survival.

Hemoperitoneum due to a Ruptured Gastric Stromal Tumor

“…Massive intraperitoneal bleeding, as occurred in our patient, is an exceptional complication associated with high mortality rates [12, 13]. No case of hemoperitoneum was reported in the retrospective studies by Cooper et al [9]and Sanders et al [10]. Tsianos et al [14]found 12 cases of intraperitoneal hemorrhage in a review of the literature of more than 1,100 cases of smooth muscle tumors of the gastrointestinal tract.…”

“…However studies of these tumors are limited and even large series have relatively few patients. Cooper et al [9]reviewed 102 cases reported during 30 years in two centers and Sanders et al [10]found 46 cases treated at the Lahey Clinic for 35 years. Gastric stromal tumors are more frequent in males than females and occur in adult patients, especially between the 5th and 7th decade.…”

Laparoscopic wedge resection of a gastric leiomyoma

“…In fact, biopsies from endoscopy yield the diagnosis in less than 60% of the time. 10,11 Although some authors feel that more extensive resections may be necessary for high-grade leiomyosarcoma, 12 others believe that a wedge resection is sufficient for leiomyosarcomas. 8,9 Four major laparoscopic methods have been described for the resection of gastric leiomyoma.…”

Abdominal gastrointestinal stromal tumours: a study of twelve patients

“…The primary treatment of GIST is a surgical resection with a negative tumour free margin of at least 2 cm is recommended 18,19 . A meticulous surgical technique is necessary to avoid intra-operative tumour rupture, which is associated with a poor prognosis.…”