Acute Upper Gastrointestinal Bleeding as Initial Presentation of Gastric LMS

Background

Gastric leiomyosarcoma is a rare malignant neoplasm that accounts for only 1% of all malignant gastric tumors, according to the literature. Its atypical presentations, such as acute upper gastrointestinal hemorrhage, can lead to misdiagnosis and delayed treatment. Understanding the clinical characteristics and diagnostic pitfalls associated with gastric LMS is crucial for timely intervention.

Data Highlights

The patient presented with a hemoglobin level of 70 g/L and a 1.2  1.8 cm ulcerated submucosal protrusion observed during gastroscopy. Final pathology confirmed a 5.0  3.0  1.5 cm tumor with a Ki-67 index of 50% and a mitotic count of 13/10 HPF.

Key Findings

• Acute upper gastrointestinal hemorrhage can be the sole initial manifestation of gastric LMS.
• Preoperative imaging and superficial biopsies may underestimate the extent and aggressiveness of gastric LMS.
• The final pathology revealed a significant increase in the Ki-67 index from 25% in the biopsy to 50% in the resected tumor.
• Immunohistochemical analysis is essential to differentiate gastric LMS from gastrointestinal stromal tumors (GISTs).
• Close postoperative surveillance is warranted due to the aggressive nature of gastric LMS.

Clinical Implications

Accurate diagnosis of gastric LMS requires comprehensive immunohistochemical profiling and careful evaluation of imaging findings.

Conclusion

This case highlights the atypical presentation of gastric LMS and the importance of thorough diagnostic evaluation.

Related Resources & Content

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