Primary leiomyosarcomas of the gastrointestinal tract in the post–gastrointestinal stromal tumor era

Aggarwal, Gitika; Sharma, Suash; Zheng, Min; Reid, Michelle D.; Crosby, John H.; Chamberlain, Sherman; Nayak-Kapoor, Asha; Lee, Jeffrey R.

doi:10.1016/j.anndiagpath.2012.07.005

Cited by 83 publications

(86 citation statements)

References 46 publications

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“…That is, the previously diagnosed gastrointestinal LMS is considered to include what is currently termed GIST [5]. According to the recent literature, the incidence of LMS was reported to be 1/50 to 1/65 of the incidence of GIST [2, 5]. LMS originates from smooth muscle cells and can arise anywhere in human body, although the main locations of LMS are the retroperitoneum, lower extremities, and the uterus [6].…”

Section: Discussionmentioning

confidence: 99%

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Transanal total mesorectal excision for a large leiomyosarcoma at the lower rectum: a case report and literature review

et al. 2017

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BackgroundRectal leiomyosarcoma (LMS) is an extremely rare disease. Previously, LMS was not properly distinguishable from gastrointestinal stromal tumor (GIST) until c-kit, a characteristic marker of GIST, was discovered in 1998. No standard therapeutic strategy for gastrointestinal LMS has been established except for surgical resection because of its rarity. Rectal LMS is often accompanied by symptoms, which can enable detection at a small size. However, when a large LMS is detected at the lower rectum, it is difficult to excise due to the narrow pelvic space.Case presentationWe present the case of an 86-year-old man with a large LMS. The LMS was asymptomatic and incidentally found at the lower rectum when he visited another hospital for management of benign prostatic hypertrophy. An abdominoperineal resection of the rectum was performed with combined resection of both seminal vesicles and a part of the prostate because tumor invasion was suspected. We used the hybrid method of laparoscopic and transanal total mesorectal excision (TaTME) approaches to achieve negative surgical margins. Late-onset urethral injury occurred in the postoperative course, which was successfully treated with a urethral catheter. The patient was discharged and received no adjuvant therapy. Local recurrence did not occur, but multiple lung metastases were detected 4 months later and the patient died 12 months after the surgery.ConclusionsThis is the first report of the hybrid method of laparoscopic and TaTME approaches to remove a large LMS at the lower rectum.

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Section: Discussionmentioning

confidence: 99%

“…Rectal LMS is usually detected at a smaller size compared with colonic LMS because there are often symptoms in rectal LMS [2]. However, when a large tumor is found in the lower rectum, it is difficult to excise because of the narrow pelvic space.…”

Section: Introductionmentioning

confidence: 99%

Transanal total mesorectal excision for a large leiomyosarcoma at the lower rectum: a case report and literature review

et al. 2017

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“…Factors that portend poor prognosis are poorly/undifferentiated tumors, high mitotic index and presence of tumor necrosis. Other factors which suggest poor prognosis is large size, location and depth of the tumor [41]. Unlike sarcomas of the extremity and retroperitoneum the role of radiotherapy in small bowel leiomyosarcoma is unclear.…”

Section: Leiomyosarcomamentioning

confidence: 93%

Small bowel sarcoma: Tumor biology and advances in therapeutics

Shenoy

2015

Surgical Oncology

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“…These tumors consist of intersecting groups of spindle cells and demonstrate high cellularity, abundant mitotic figures, and necrosis (23). Some high-grade sarcomas cannot be further classified despite ancillary studies such as immunohistochemical stains, and they may be diagnosed as "unclassified.…”

Section: Non-gist Sarcomamentioning

confidence: 98%

Beyond the GIST: Mesenchymal Tumors of the Stomach

Kang¹,

Menias²,

Gaballah³

et al. 2013

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Intramural gastric masses arise in the wall of the stomach (generally within the submucosa or muscularis propria), often with intact overlying mucosa. These tumors are typically mesenchymal in origin and have overlapping radiologic appearances. A combination of features such as location, attenuation, enhancement, and growth pattern may suggest one diagnosis over another. Gastrointestinal stromal tumors (GISTs) account for the majority of intramural tumors and can vary widely in appearance, from small intraluminal lesions to exophytic masses that protrude into the peritoneal cavity, commonly with areas of hemorrhage or necrosis. A well-circumscribed mass measuring -70 to -120 HU is a lipoma. Leiomyomas usually manifest as low-attenuation masses at the gastric cardia. Homogeneous attenuation is a noteworthy characteristic of schwannomas, particularly for larger lesions that might otherwise be mistaken for GISTs. A hypervascular mass in the antrum is a common manifestation of glomus tumors. Hemangiomas are also hypervascular but often manifest in childhood. Inflammatory fibroid polyps usually arise as a polypoid mass in the antrum. Inflammatory myofibroblastic tumors are infiltrative neoplasms with a propensity for local recurrence. Plexiform fibromyxomas are rare, usually antral tumors. Carcinoid tumors are epithelial in origin, but often submucosal in location, and therefore should be distinguished from other intramural lesions. Multiple carcinoid tumors are associated with hypergastrinemia, either in the setting of chronic atrophic gastritis or Zollinger-Ellison syndrome. Sporadic solitary carcinoid tumors not associated with hypergastrinemia have a higher rate of metastasis. Histopathologic analysis, including immunohistochemistry, is usually required for diagnosis of intramural masses.

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Primary leiomyosarcomas of the gastrointestinal tract in the post–gastrointestinal stromal tumor era

Cited by 83 publications

References 46 publications

Transanal total mesorectal excision for a large leiomyosarcoma at the lower rectum: a case report and literature review

Transanal total mesorectal excision for a large leiomyosarcoma at the lower rectum: a case report and literature review

Small bowel sarcoma: Tumor biology and advances in therapeutics

Beyond the GIST: Mesenchymal Tumors of the Stomach

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