AN OPERATED CASE OF MALIGNANT LEIOMYOBLASTOMA OF THE STOMACH

A 42-year-old woman visited the hospital because of upper abdominal pain and tumor. Gastric barium study showed the compression on lesser curvature, but mucosal appearance was normal on the gastrofiberscopy, and all tumor markers were in normal ranges. Ultrasonography, CT and MRI showed an over 10 cm size unhomogenous tumor between the liver and pancreas adjacent to stomach. Total gastrectomy with regional lymph nodes dissection was carried out under a presumptive diagnosis of leiomyosarcoma. No lymph node metastasis was found. Histologically it was diagnosed as malignant leiomyoblastoma of the stomach. Four months later a tumor which might be a metastatic lesion was detected around the pancreas tail on CT. The tumor rapidly enlarged. On the 5th month after the operation, relaparotomy was performed and metastasizing lesion was also confirmed in the lateral segment of the liver. Resection of the pancreas tail, splenectomy and partial resection of the liver were carried out, followed by adjuvant chemotherapy.There is an opinion that this tumor has a low grade of malignity compared to carcinomas and can be successfully treated by a small operation. However, radical operation which involves lymph node dissection and adjuvant chemotherapy seems to be necessary as in gastric cancer and leiomyoblastoma, even to this tumor, particularly to those with high rate of nucleomitosis.