Leiomyosarcoma of the Stomach with Metastasis to the Liver: A Case Report With Review of the Literature

Abstract

Leiomyosarcoma of the stomach is a very rare malignancy that was not distinguished from the more frequent gastrointestinal stromal tumors until early 2000s. Here we report on a case of a metastatic disease that developed in a 47-year-old man 2 years after he was diagnosed with the primary tumor and treated with curative surgical excision and adjuvant doxorubicin. The primary and metastatic lesions were positive for smooth muscle markers α-smooth muscle actin and h-caldesmon and negative for CD117, DOG-1 and S100 by immunohistochemistry. Metastatic disease progressed on additional monotherapy with doxorubicin and docetaxel–gemcitabine combination, and stable disease was achieved upon treatment with pazopanib. Patient is surviving 35 months since diagnosis of the primary tumor and 11 months since diagnosis of metastatic disease.

Metastatic leiomyosarcoma of the excluded stomach: a case report

“…And his poor outcome included recent implants in bones, lungs, and the central nervous system. There was no remarkable response of distant metastases to the chemotherapy schedules [6]. Because of the development of brain implants, he was referred to treatment by radiotherapy.…”

“…Leiomyosarcoma (LMS) represents about 1% of primary malignancies of the stomach, evolves with hepatic implants in 2-thirds of cases, and the outcome is often poor [1][2][3][4][5][6][7]. Immunosuppression, Epstein-Barr virus, chemicals, and radiation can be related factors [2,6]. Spindle cells of the muscularis propria or muscularis mucosa present high proliferation rates and positivity for desmin, a-muscle-specific actin, and vimentin [2,3,6].…”

“…Immunosuppression, Epstein-Barr virus, chemicals, and radiation can be related factors [2,6]. Spindle cells of the muscularis propria or muscularis mucosa present high proliferation rates and positivity for desmin, a-muscle-specific actin, and vimentin [2,3,6]. Although immunohistochemical findings can avoid pitfalls with other gastrointestinal tumors, the diagnosis often occurs at late stages because of the insidious clinical course [2][3][4][5][6][7].…”

“…Spindle cells of the muscularis propria or muscularis mucosa present high proliferation rates and positivity for desmin, a-muscle-specific actin, and vimentin [2,3,6]. Although immunohistochemical findings can avoid pitfalls with other gastrointestinal tumors, the diagnosis often occurs at late stages because of the insidious clinical course [2][3][4][5][6][7]. LMS predominantly affects female adults (5:3) and the sixth decade of life, pain occurs in near 75% of patients and the control is very difficult in most of them [1,2].…”

“…Recurrences after resections and distant metastases may develop in up to 50% of patients [5]. Anthracycline-based chemotherapy, ifosfamide, gemcitabine, docetaxel, trabectedin, and pazopanib constitute additional therapeutic options, with variable response rates [6,7]. Because of the exceeding rarity, case reports can increase the understanding of gastric LMS.…”