Léiomyosarcome gastrique simulant une tumeur du hile splénique: à propos d’un cas

Abstract

Depuis la découverte de leur phénotype particulier, les tumeurs stromales gastro-intestinales représentent les tumeurs mésenchymateuses les plus fréquentes du tractus digestif et ne sont plus confondues avec les vrais léiomyosarcomes gastriques devenant ainsi exceptionnellement rencontrés dans la pratique médicale. Nous rapportons le cas d'une jeune femme de 32 ans admise pour une masse douloureuse de l'hypochondre gauche et chez qui le bilan radiologique objectivait une volumineuse tumeur occupant le hile splénique. Une résection monobloc emportant la masse, la rate, le grand épiploon et une collerette de la paroi gastrique a été effectuée et l'examen histologique a confirmé le diagnostic d'un léiomyosarcome gastrique. Il est extrêmement important de différencier les autres tumeurs mésenchymateuses du tractus digestif des léiomyosarcomes gastriques dont l'exérèse chirurgicale complète reste, jusqu’à présent, le seul traitement à visée curative.

Gastric Leiomyosarcoma in Post–Gastrointestinal Stromal Tumor Era: Revisit

“…19 Abdominal computed tomography scans (Fig. 1) may reveal a mass 20,21 or thickening of the gastric wall, 22 with soft tissue density 21,23 or hyperdensity. 15 Post-contrast imaging may display heterogeneous or inhomogeneous enhancement 9,23 or homogeneous enhancement.…”

“…1) may reveal a mass 20,21 or thickening of the gastric wall, 22 with soft tissue density 21,23 or hyperdensity. 15 Post-contrast imaging may display heterogeneous or inhomogeneous enhancement 9,23 or homogeneous enhancement. 10 Magnetic resonance imaging may show the tumor as hypointense on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging with isointense streaks within the tumor.…”

“…The majority of biopsy results can confirm leiomyosarcoma, whereas other cases indicated no abnormality. 16,19,23,29 Uncommon findings include hyperplastic polyp, 30 leiomyoma, 31 smooth muscle/spindle cell tumor, 9,15,32 sarcoma with muscular differentiation, 13 and dysplasia. 22 Fine needle aspiration/biopsy from some cases 4,10,16 revealed bundles of well-differentiated spindle cells with blunt-ended nuclei and eosinophilic cytoplasm, devoid of mitotic figures, typically indicate spindle cell neoplasia with myogenic differentiation.…”

“…The majority of biopsy results can confirm leiomyosarcoma, whereas other cases indicated no abnormality 16,19,23,29 . Uncommon findings include hyperplastic polyp, 30 leiomyoma, 31 smooth muscle/spindle cell tumor, 9,15,32 sarcoma with muscular differentiation, 13 and dysplasia 22 …”

Analysis of feasibility, safety and effectiveness of ultrasound-guided percutaneous microwave ablation of splenic neoplasm

“…However, with the continuous improvement of imaging technique, the detection rate of spleen neoplasm is gradually increased. Consequently, the proportion in the diagnosis and treatment of the tumors also shows a rising trend, posing a serious threat to the human life and health ( 3 ). The treatment methods of splenic neoplasm mainly include the splenic artery embolization, splenectomy, splenic hilar lymph node dissection ( 4 ).…”